Treating Intention In Aphasia: Neuroplastic Substrates
Condition: Aphasia; Cerebrovascular Accident
MeSH terms: Aphasia; Stroke
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The purpose of this study is to determine if an "intentional act" improves treatment response
      for patients with nonfluent aphasia. The treatment involves naming pictures and saying
      members of categories. The "intentional act" requires initiating picture naming or category
      member trials with a left-hand movement sequence. Nonfluent aphasia is a disorder of language
      production in which patients with damage to the brain's language system have trouble
      initiating and maintaining spoken communication. All patients participating in the study take
      part in functional MRI scans to determine how treatments affect brain systems.
    

Detailed description: 
      A new treatment manipulating intention substrates for language production in "nonfluent"
      aphasia patients was developed. The intention component involves initiating word-finding
      trials with a complex left-hand movement. The study addresses (1) whether or not the
      intention manipulation (complex left-hand movement) makes a unique contribution to treatment
      outcome and (2) whether or not the intention manipulation helps to shift word production
      mechanisms from the left to the right frontal lobe. All study participants take part in
      functional magnetic resonance imaging (fMRI) scans of word-finding before and after treatment
      and at 3-month follow-up to measure changes in lateralization of frontal lobe activity during
      word finding. Only patients with a substantial degree of left frontal activity on the
      pre-treatment fMRI scan can participate. There are three specific aims: (1) to determine if
      repetitive initiation of word production with a complex left-hand movement leads to increased
      right-hemisphere lateralization of frontal activity and if these changes can be attributed to
      the intention component of treatment, (2) to determine whether activity in posterior
      perisylvian cortices that is entrained to right frontal activity shows a greater increase in
      right-hemisphere lateralization from pre- to post-treatment fMRI when the intention component
      is included in treatment, and (3) to determine whether onset of hemodynamic responses (HDRs)
      in right motor/premotor cortex becomes more closely associated with the temporal onset of
      participants' spoken responses across treatment when the intention component is included in
      treatment. If successful, the treatment can provide a new treatment vehicle for increasing
      language function in patients with "nonfluent" aphasia.
    

Intervention name(s): Word-finding with intention component; Word-finding with no intention component
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Word-finding trials (picture-naming) with intention manipulation (initiating word-finding trials with a complex left-hand movement). 8 (or more) baseline sessions over 4 days followed by 30 treatment sessions (2 sessions/day, 5 days/week for 3 weeks).; Word-finding trials with no intention manipulation. 8 (or more) baseline sessions in 4 days followed by 30 treatment sessions (2 sessions/day, 5 days/week for 3 weeks).
Other intervention name(s): Intention Treatment; Control Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: aphasia; therapies, investigational; rehabilitation of speech and language disorders; magnetic resonance imaging, functional; language