Dataset Information

Neuroplasticity in Aphasia: A Proposed Framework of Language Recovery.

ABSTRACT: Purpose Despite a tremendous amount of research in this topic, the precise neural mechanisms underlying language recovery remain unclear. Much of the evidence suggests that activation of remaining left-hemisphere tissue, including perilesional areas, is linked to the best treatment outcomes, yet recruitment of the right hemisphere for various language tasks has also been linked to favorable behavioral outcomes. In this review article, we propose a framework of language recovery that incorporates a network-based view of the brain regions involved in recovery. Method We review evidence from the extant literature and work from our own laboratory to identify findings consistent with our proposed framework and identify gaps in our current knowledge. Results Expanding on Heiss and Thiel's (2006) hierarchy of language recovery, we identify 4 emerging themes: (a) Several bilateral regions constitute a network engaged in language recovery; (b) spared left-hemisphere regions are important components of the network engaged in language recovery; (c) as damage increases in the left hemisphere, activation expands to the right hemisphere and domain-general regions; and (d) patients with efficient, control-like network topology show greater improvement than patients with abnormal topology. We propose a mechanistic model of language recovery that accounts for individual differences in behavior, network topology, and treatment responsiveness. Conclusion Continued work in this topic will lead us to a better understanding of the mechanisms underlying language recovery, biomarkers that influence recovery, and, consequently, more personalized treatment options for individual patients. Presentation Video https://doi.org/10.23641/asha.10257590.

SUBMITTER: Kiran S

PROVIDER: S-EPMC7203519 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Neuroplasticity in Aphasia: A Proposed Framework of Language Recovery.

Kiran Swathi S Meier Erin L EL Johnson Jeffrey P JP

Journal of speech, language, and hearing research : JSLHR 20191122 11

Purpose Despite a tremendous amount of research in this topic, the precise neural mechanisms underlying language recovery remain unclear. Much of the evidence suggests that activation of remaining left-hemisphere tissue, including perilesional areas, is linked to the best treatment outcomes, yet recruitment of the right hemisphere for various language tasks has also been linked to favorable behavioral outcomes. In this review article, we propose a framework of language recovery that incorporates ...[more]

PMID: 31756154

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Project description:BackgroundThere is high variability in post-stroke aphasia severity and predicting recovery remains imprecise. Standard prognostics do not include neurophysiological indicators or genetic biomarkers of neuroplasticity, which may be critical sources of variability.ObjectiveTo evaluate whether a common polymorphism (Val66Met) in the gene for brain-derived neurotrophic factor (BDNF) contributes to variability in post-stroke aphasia, and to assess whether BDNF polymorphism interacts with neurophysiological indicators of neuroplasticity (cortical excitability and stimulation-induced neuroplasticity) to improve estimates of aphasia severity.MethodsSaliva samples and motor-evoked potentials (MEPs) were collected from participants with chronic aphasia subsequent to left-hemisphere stroke. MEPs were collected prior to continuous theta burst stimulation (cTBS; index for cortical excitability) and 10 minutes following cTBS (index for stimulation-induced neuroplasticity) to the right primary motor cortex. Analyses assessed the extent to which BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to predict aphasia severity beyond established predictors.ResultsVal66Val carriers showed less aphasia severity than Val66Met carriers, after controlling for lesion volume and time post-stroke. Furthermore, Val66Val carriers showed expected effects of age on aphasia severity, and positive associations between severity and both cortical excitability and stimulation-induced neuroplasticity. In contrast, Val66Met carriers showed weaker effects of age and negative associations between cortical excitability, stimulation-induced neuroplasticity and aphasia severity.ConclusionsNeurophysiological indicators and genetic biomarkers of neuroplasticity improved aphasia severity predictions. Furthermore, BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to improve predictions. These findings provide novel insights into mechanisms of variability in stroke recovery and may improve aphasia prognostics.

Project description:Aphasia, the impairment to understand or produce language, is a frequent disorder after stroke with devastating effects. Conventional speech and language therapy include each formal intervention for improving language and communication abilities. In the chronic stage after stroke, it is effective compared with no treatment, but its effect size is small. We present a new language training approach for the rehabilitation of patients with aphasia based on a brain-computer interface system. The approach exploits its capacity to provide feedback time-locked to a brain state. Thus, it implements the idea that reinforcing an appropriate language processing strategy may induce beneficial brain plasticity. In our approach, patients perform a simple auditory target word detection task whilst their EEG was recorded. The constant decoding of these signals by machine learning models generates an individual and immediate brain-state-dependent feedback. It indicates to patients how well they accomplish the task during a training session, even if they are unable to speak. Results obtained from a proof-of-concept study with 10 stroke patients with mild to severe chronic aphasia (age range: 38-76 years) are remarkable. First, we found that the high-intensity training (30 h, 4 days per week) was feasible, despite a high-word presentation speed and unfavourable stroke-induced EEG signal characteristics. Second, the training induced a sustained recovery of aphasia, which generalized to multiple language aspects beyond the trained task. Specifically, all tested language assessments (Aachen Aphasia Test, Snodgrass & Vanderwart, Communicative Activity Log) showed significant medium to large improvements between pre- and post-training, with a standardized mean difference of 0.63 obtained for the Aachen Aphasia Test, and five patients categorized as non-aphasic at post-training assessment. Third, our data show that these language improvements were accompanied neither by significant changes in attention skills nor non-linguistic skills. Investigating possible modes of action of this brain-computer interface-based language training, neuroimaging data (EEG and resting-state functional MRI) indicates a training-induced faster word processing, a strengthened language network and a rebalancing between the language- and default mode networks.

Dataset Information

Neuroplasticity in Aphasia: A Proposed Framework of Language Recovery.

Publications

Neuroplasticity in Aphasia: A Proposed Framework of Language Recovery.

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