Brain plasticity and recovery of auditory comprehension in chronic post-stroke aphasia

Stroke is the leading cause of adult disability in the USA and aphasia is a common consequence of dominant-hemispheric strokes. It is unclear why some recover with speech therapy, while others persist with debilitating deficits. One theory suggests that therapy-related brain plasticity provides the anatomical substrate for improvements in language. In this longitudinal study, we assessed the integrity of the ipsi- and contralateral inferior longitudinal fasciculus (ILF) using diffusional kurtosis MRI (DKI), and examined its relationship with aphasia-therapy related changes in semantic errors. 8 subjects (age = 52.0±7.2y; 62% male; MRI time post-stroke = 50.25±29.8m) with chronic post-stroke aphasia received Language Action Therapy for a period of 3 weeks. Structural images (T1 & T2) and DKI (30 directions, b= [1000, 2000 s/mm 2 ]) were acquired. We applied an innovative form of tractography using Diffusion Kurtosis Estimator and a WM mask as a seeding region. Lastly, we optimized the automated fiber quantification software to acquire along-tract diffusion measurements resulting in 100 nodal mean kurtosis (MK), mean diffusivity (MD) and fractional anisotropy (FA) measurements along major tracts. Compared to the contralateral side, the ipsilateral ILF shows diffusion characteristics often found in damaged neuronal tissue: high MD, low FA, and low MK (figure1). The variability is larger on the ipsilateral side, and lowest MK correlated significantly with an increase in semantic errors (r=-0.84, p<0.05). None of the associations with FA and MD reached significance. Additionally, a therapy related reduction in semantic errors was associated with a longitudinal increase in MK (r=-0.89, p<0.05). In conclusion, ILF integrity captured using MK relates to clinical performance with lower MK predicting worse semantic language production, whereas therapy related increases in microstructural complexity (higher MK) were associated with a decrease in semantic errors.

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Clinical Effectiveness of The Queen Square Intensive Comprehensive Aphasia Service for Patients With Post-Stroke Aphasia

10.31219/osf.io/ckq6u ◽

2021 ◽

Author(s):

Alex Leff ◽

Jenny Crinion

Keyword(s):

Language Production ◽

Clinical Effectiveness ◽

Functional Communication ◽

Auditory Comprehension ◽

Language Therapy ◽

Post Stroke ◽

Time Interaction ◽

Short Period ◽

High Doses ◽

Uk National Health Service

BACKGROUND AND PURPOSE: Post-stroke aphasia has a major impact on peoples’ quality of life. Speech and language therapy interventions work, especially in high doses, but these doses are rarely achieved outside of research studies. Intensive Comprehensive Aphasia Programmes (ICAPs) are an option to deliver high doses of therapy to people with aphasia (PWA) over a short period of time. Here we report the clinical effectiveness of the Queen Square ICAP, a clinical-academic service set up in partnership between charities and the UK national health service (NHS).METHODS: Forty-six PWA in the chronic stage post-stroke completed the ICAP over a 3- week period. Outcome measures included the Comprehensive Aphasia Test, an impairment- based test of the four main domains of language (speaking, writing, auditory comprehension and reading) which was measured at three time points (Baseline, immediately post- treatment at 3-Weeks and follow-up at 3-Months); and, the Communicative Effectiveness Index (CETI), a carer-reported measure of functional communication skills collected at Baseline and 3-Months.RESULTS: We found a significant domain-by-time interaction indicating that the ICAP improved PWA’s language scores across all four domains, with the largest gains in speaking. All gains were maintained or significantly improved further by 3-Months post ICAP. Importantly patients’ functional communication, as indexed by changes on the CETI, also significantly improved at 3-Months. Effect sizes were large for changes in language production and the CETI, and medium for changes in language perception.CONCLUSIONS: PWA who participated in the Queen Square ICAP made large and clinically meaningful gains on both impairment-based and functional measures of language. Gains were sustained and in some cases improved further over the subsequent 3 months.Key words: Aphasia, ICAP, impairment, function, languageAbbreviations: CAT (comprehensive aphasia test), CETI (communicative effectivenessindex), ICAP (intensive comprehensive aphasia programme), PWA (people with aphasia).

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The Efficacy and Safety of Pharmacological Treatments for Post-stroke Aphasia

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527317666180706143051 ◽

2018 ◽

Vol 17 (7) ◽

pp. 509-521 ◽

Cited By ~ 6

Author(s):

Xiaoyan Zhang ◽

Bohui Shu ◽

Dongdong Zhang ◽

Lina Huang ◽

Qizhi Fu ◽

...

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Spontaneous Speech ◽

Current Evidence ◽

Controlled Trials ◽

Auditory Comprehension ◽

Efficacy And Safety ◽

Pharmacological Treatments ◽

Post Stroke ◽

Oral Expression

Background: Aphasia is a common complication after stroke, and traditional speech and language therapy (SLT) has a limited effect on post-stroke aphasia (PSA). While there has been an increasing number of controlled clinical trials on the efficacy of drugs in the treatment of PSA, there have been very few systematic reviews on the efficacy and safety of pharmacological treatments in people with PSA. Objective: To evaluate the efficacy and safety of pharmacological interventions for PSA. Methods: The Cochrane Central Register of Controlled Trials (CENTRA), PubMed, Embase, Chinese Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Wanfang Data and VIP Information System were searched for randomized controlled trials about pharmacological treatments for PSA. Literature screening using the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two independent reviewers. Methodological quality was considered high for modified Jadad quality scale scores of 4 to 7. RevMan 5.3 software was used to conduct a meta-analysis of high-quality studies. Results: Fifteen studies (578 participants) satisfied the eligibility criteria for this systematic review. Five trials (277 participants) assessed donepezil, four studies (124 participants) assessed memantine, three studies (72 participants) assessed bromocriptine, one trial (45 patients) evaluated galantamine, one study (21 patients) evaluated amphetamine, and one trial (39 patients) evaluated levodopa. The systematic review showed that donepezil achieved remarkable results in terms of the aphasia quotient (AQ) (SMD 0.82, 95% CI 0.48-1.17, P < 0.00001), repetition ability (SMD 0. 81, 95% CI 0.57-1.06, P < 0.00001), naming ability (SMD 0.56, 95% CI 0.29-0. 84, P < 0.00001), auditory comprehension (SMD 0.85, 95% CI 0.58-1. 13, P< 0.00001) and oral expression (SMD 0.90, 95% CI 0.54-1.26, P < 0.00001). Memantine showed no pronounced improvement in auditory comprehension (SMD 0.35, 95% CI -0.05-0.74, P = 0.09) but did improve the AQ (SMD 0.57, 95% CI 0.09-1.06, P = 0. 02), naming ability (SMD 0.81, 95% CI 0.38-1.25, P = 0.0002), spontaneous speech (SMD 0.76, 95% CI 0. 39- 1.13, P < 0.0001), and repetition ability (SMD 0.37, 95% CI 0.01-0.73, P = 0.04). Bromocriptine showed pronounced improvement in naming ability (SMD -0.20, 95% CI- 0.67-0.26, P = 0.39), verbal fluency (SMD 0.02, 95% CI 0.53-0.56, P = 0.95), and repetition ability (SMD 0.29, 95% CI -0.23-0. 81, P = 0.28). There is limited and inconclusive evidence for galantamine, amphetamine and levodopa. Conclusion: Current evidence suggests that drugs, such as donepezil and memantine, can improve the prognosis of PSA. Donepezil has a significant effect in improving the ability of auditory comprehension, naming, repetition and oral expression. Memantine has a significant effect in improving the ability of naming, spontaneous speech and repetition. Bromocriptine showed no significant improvements in the treatment of aphasia after stroke. Data regarding galantamine, amphetamine and levodopa in the treatment of aphasia after stroke are limited and inconclusive.

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White Matter Correlates of Auditory Comprehension Outcomes in Chronic Post-Stroke Aphasia

Frontiers in Neurology ◽

10.3389/fneur.2017.00054 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 9

Author(s):

Shihui Xing ◽

Elizabeth H. Lacey ◽

Laura M. Skipper-Kallal ◽

Jinsheng Zeng ◽

Peter E. Turkeltaub

Keyword(s):

White Matter ◽

Auditory Comprehension ◽

Post Stroke

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Correlates of Post-Stroke Brain Plasticity, Relationship to Pathophysiological Settings and Implications for Human Proof-of-Concept Studies

Frontiers in Cellular Neuroscience ◽

10.3389/fncel.2016.00196 ◽

2016 ◽

Vol 10 ◽

Cited By ~ 5

Author(s):

Eduardo H. Sanchez-Mendoza ◽

Dirk Matthias Hermann

Keyword(s):

Brain Plasticity ◽

Proof Of Concept ◽

Post Stroke

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Abstract T MP46: Stroke-Related Neuroplasticity During Steering of Human Gait

Stroke ◽

10.1161/str.45.suppl_1.tmp46 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Caroline Paquette ◽

Jean-Paul Soucy

Keyword(s):

Brain Plasticity ◽

Brain Activity ◽

Brain Regions ◽

Whole Body ◽

Human Gait ◽

Stroke Survivors ◽

Post Stroke ◽

Positron Emission ◽

18F Fdg

Background: The risk of falling is higher in stroke survivors than among the general population. These falls are more frequent during walking and transfers or during turning. The neuronal substrates involved in steering of locomotion are poorly understood due to methodological limitations in quantifying brain activations during whole-body movements. Thus, no data is currently available to study the mechanisms of post-stroke brain plasticity for steering of gait. This study tested the hypothesis that stroke-induced neuroplastic changes for steering of gait can be quantified using 18F- fluorodesoxy-glucose (18F-FDG) Positron Emission Tomography (PET) in-vivo in humans Methods: PET imaging with 18F-FDG tracer was used to quantify cerebral glucose metabolism (CMRGlc) during two locomotor tasks (straight walking and turning) measured on separate days. Immediately prior to each walking task, a 5 mCi bolus of 18F-FDG was injected. Subjects walked for 40 minutes (duration of 18F-FDG uptake). Subjects were scanned on an ECAT HR+ scan (20min emission followed by 10min transmission) within 10 minutes of completing the walking task, well within reaching the 2h half-life of 18F. Images obtained during straight walking were subtracted from the ones acquired during steering Results: Subjects post-stroke showed an asymmetrical pattern of CMRGlc in sensorimotor areas and superior parietal lobule where the affected hemisphere shows no increase in CMRGlc. Differences between groups were also observed in the cerebellum where CMRGlc was increased in the vermis for controls, an area predominant for the control of trunk and gait. Stroke subjects, in contrast, showed increased CMRGlc in the hemishperes, associated with goal-directed leg movements. Conclusions: Neuroplasticity in complex locomotor tasks such as steering can be quantified using 18F-FDG PET in subjects post-stroke. This study showed that changes affect several brain regions remote to the infarct. Understanding stroke-related changes in brain activity during steering of locomotion is crucial for improving rehabilitative strategies to minimize falls and injuries in stroke survivors.

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Communication disorders post-stroke

Stroke in the Older Person ◽

10.1093/med/9780198747499.003.0013 ◽

2020 ◽

pp. 213-230

Author(s):

Dee Webster ◽

Sally Knapp

Keyword(s):

Communication Disorders ◽

International Classification Of Functioning ◽

Specific Reference ◽

Auditory Comprehension ◽

Post Stroke ◽

Assessment And Treatment ◽

Related Quality ◽

Health Related ◽

The Impact

‘Communication disorders after stroke’ examines the common communication disorders which occur post-stroke and their impact on all aspects of daily life for the older person. It describes impairments of language and speech: aphasia, dysarthria, and apraxia of speech, outlining the theoretical models underpinning assessment and treatment, with specific reference to auditory comprehension, reading, the production of spoken language and spelling. The International Classification of Functioning framework which guides the assessment and rehabilitation of communication disorders, and the methods used to assess breakdown of communication are detailed. The role of the speech and language therapist is explored. The impact of spontaneous recovery and the internal and external factors which impact on suitability for therapy are described. The role of collaborative goal setting is outlined and intervention approaches targeted at the level of the impairment and at increasing communicative activity and social and life participation are explored. The impact of digital literacy, health-related quality of life, and the challenges of the care home setting on the older population are also examined.

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Stochastic Resonance Stimulation in Brain Plasticity and Post Stroke Motor Recovery

Case Medical Research ◽

10.31525/ct1-nct03839810 ◽

2000 ◽

Author(s):

Keyword(s):

Stochastic Resonance ◽

Brain Plasticity ◽

Motor Recovery ◽

Post Stroke

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New Insights Into the Roles of Microglial Regulation in Brain Plasticity-Dependent Stroke Recovery

Frontiers in Cellular Neuroscience ◽

10.3389/fncel.2021.727899 ◽

2021 ◽

Vol 15 ◽

Author(s):

Fang Yu ◽

Tingting Huang ◽

Yuanyuan Ran ◽

Da Li ◽

Lin Ye ◽

...

Keyword(s):

Microglial Activation ◽

Brain Injuries ◽

Inflammatory Responses ◽

Brain Plasticity ◽

Functional Restoration ◽

Stroke Recovery ◽

Special Focus ◽

Post Stroke ◽

Functional Connections

Stroke remains the leading cause of long-term disability worldwide with significant long-term sequelae. However, there is no highly effective treatment to enhance post-stroke recovery despite extensive efforts in exploring rehabilitative therapies. Neurorehabilitation is recognized as the cornerstone of functional restoration therapy in stroke, where treatments are focused on neuroplastic regulation to reverse neural structural disruption and improve neurofunctional networks. Post-stroke neuroplasticity changes begin within hours of symptom onset and reaches a plateau by 3 to 4 weeks within the global brain in animal studies. It plays a determining role in spontaneous stroke recovery. Microglia are immediately activated following cerebral ischemia, which has been found both proximal to the primary ischemic injury and at the remote brain regions which have functional connections to the primary injury area. Microglia exhibit different activation profiles based on the microenvironment and adaptively switch their phenotypes in a spatiotemporal manner in response to brain injuries. Microglial activation coincides with neuroplasticity after stroke, which provides the fundamental base for the microglia-mediated inflammatory responses involved in the entire neural network rewiring and brain repair. Microglial activation exerts important effects on spontaneous recovery after stroke, including structural and functional reestablishment of neurovascular networks, neurogenesis, axonal remodeling, and blood vessel regeneration. In this review, we focus on the crosstalk between microglial activation and endogenous neuroplasticity, with a special focus on the plastic alterations in the whole brain network and their implications for structural and functional restoration after stroke. We then summarize recent advances in the impacts of microglial phenotype polarization on brain plasticity, trying to discuss the potential efficacy of microglia-based extrinsic restorative interventions in promoting post-stroke recovery.

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