Neural Networks and Language Recovery in Aphasia From Stroke: fMRI Studies
Condition: Aphasia; Nonfluent Aphasia; Stroke
MeSH terms: Stroke; Aphasia; Aphasia, Broca
Study type: Observational

Summary: 
      The purpose of this research is to utilize functional magnetic resonance imaging (fMRI) to
      investigate brain reorganization for language behavior in stroke patients with aphasia. A
      primary focus of the study is on recovery of nonfluent propositional speech and naming in
      chronic aphasia patients. The fMRI technique is used to examine activation in the left
      hemisphere (LH) and right hemisphere (RH), during recovery of specific language behaviors in
      chronic nonfluent aphasia patients.
    

Detailed description: 
      PURPOSE: The purpose of this 4-year fMRI research is to study brain reorganization for
      language in patients with left hemisphere (LH) stroke who have chronic nonfluent aphasia.
      This fMRI research is fundamental and critical to the PI's NIH RO1 grant, Transcranial
      Magnetic Stimulation (TMS) to Improve Speech in nonfluent aphasia, which was recently renewed
      for 5 years, 2006-11. There is no overlap in the studies. The NIH grant provides the TMS
      (real and sham). This VA grant provides 4 different fMRI tasks performed pre- and post- a
      series of TMS treatments (real and sham) - Overt Naming fMRI; Overt Propositional Speech
      fMRI; and Nonverbal Semantic Decision tasks for Nouns, and for Actions.

      The investigators have observed that application of TMS to an anterior portion of right (R)
      Broca's homologue (pars triangularis, PTr), results in significantly improved picture naming
      ability at 2 and 8 Mo. after the last (10th) TMS treatment, in aphasia patients who began TMS
      at 5-11 years poststroke. Also, half of these nonfluent aphasia patients improved their
      Phrase Length in propositional speech, post-TMS.

      RATIONALE: The investigators and others have observed that patients with chronic, nonfluent
      aphasia (poor, hesitant speech) have overactivation of R hemisphere (RH) cortical language
      homologues. The investigators hypothesize this represents a maladaptive plasticity and
      probably poor active inhibition during speech. Slow, 1 Hz TMS can be used to suppress
      cortical excitability. The goal is to use 1 Hz TMS to inhibit/suppress the overactivation in
      RH language homologues. The investigators' early TMS research has shown that suppression of R
      PTr in these patients is associated with improved speech. The fMRI studies proposed in this
      VA grant will help to investigate the neurophysiological changes underlying improvement post-
      TMS in propositional speech and in nonverbal semantic decision tasks. The new MRI technique,
      diffusion tensor imaging (DTI) will be used to study WM pathways subjacent to cortex treated
      with TMS.

      DESIGN: Randomized, sham-control, incomplete crossover design with 32 patients (16
      mild-moderate; 16 severe nonfluent), half receive real TMS series only; half, sham TMS 1st,
      and real 2nd. Language, Neuropsych. testing, and fMRIs are performed at Entry, and at 2 Mo.
      post-10 real or sham TMS treatments; and at 6 Mo. post real. There are 4 Projects: 1) fMRI
      during overt naming and propositional speech (Overt Picture Naming and Picture
      Descriptions/Story Telling; 2) fMRI during a Nonverbal Semantic Decision Task with
      Superordinate Noun Icons; 3) fMRI during a Nonverbal Semantic Decision Task with Action and
      Object Icons; 4) DTI. DTI is performed only at Entry (all subjects). Normal controls (n=8) do
      not receive TMS; they are studied with fMRI at Entry, at 2 and 6 Mo. later.

      HYPOTHESES: Following the real TMS to suppress R PTr, there will be less overactivation on
      fMRI (better modulation) in RH language homologues, and new LH activation (including L
      perilesional areas and L SMA). This will be associated with improved propositional speech
      (BDAE) and nonverbal semantic decision ability at 2 and 6 Mo. post-real TMS. No language or
      fMRI changes are expected post-sham TMS. The fMRIs performed 3x with the normal controls are
      not expected to show change, but will document the neural networks for the fMRI tasks.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Chronic stroke patients with nonfluent aphasia
      
Keywords: Adult Aphasia; Diffusion Tensor Imaging; functional Magnetic Resonance Imaging; Language Recovery; Left Middle Cerebral Artery Stroke; Nonfluent Aphasia