Impact of Art Therapy on Brain Connectivity in Recent Post-Stroke Aphasia

Study Overview
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Brief Summary
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A stroke located in the left parieto-temporal junction is associated, in aphasic right-handed patients, with a poor prognosis for language recovery. The role of the right hemisphere in recovering post-stroke aphasia is still controversial. Our hypothesis, based on recent work in imaging, is that early activation of the right hemisphere linked to the practice of the visual arts could facilitate language recovery in extended posterior left strokes that completely disrupt language areas.

Detailed Description
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The investigators will evaluate, at inclusion and at 6 weeks, the reorganization of functional and structural brain connectivity maps before and after rehabilitation of aphasia with art therapy and standard orthophonic rehabilitation versus a control group that received only standard orthophonic rehabilitation. The investigators will include all consecutive patients with recent ischemic or hemorrhagic stroke with unilateral lesion(s) of the parieto-temporal left junction present on the Diffusion MRI (DWI) performed in acute phase at 24-48h. All patients will undergo 2 MRI with tensor diffusion sequences (structural connectivity) and fMRI (functional magnetic resonance imaging) resting state sequences (functional connectivity) at inclusion and 6 weeks after rehabilitation with or without art therapy. The investigators aimed to demonstrate that early activation of the right hemisphere related to the practice of the visual arts could facilitate the recovery of language in later strokes completely disrupting the language areas of the left hemisphere.

Official Title
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Impact of Art Therapy on Brain Connectivity in Recent Post-Stroke Aphasia (ART-CONNECT)

Conditions
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Ischemic or Hemorrhagic Stroke

Intervention / Treatment
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* Other: Art therapy and standard orthophonic rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with recent ischemic or haemorrhagic stroke with unilateral lesion (s) of the parieto-temporal left junction present on the Diffusion MRI (DWI) performed in acute phase at 24-48h Post stroke delay of 15 days to 2 months Existence of moderate to severe phasic disorders on Aphasia Rapid Test score (ART, score> 6, scale of 26 items) Patient able to read and understand French Rightful Normal and corrected vision and hearing Absence of pre-existing degenerative neurological disorder Patient having signed his consent Age ≥ 18 years Exclusion Criteria: Patients with contraindications to MRI or claustrophobic Patients under legal protection Patients with behavioral disorders or disabling neurovisual disorders making participation in art therapy impossible Mute patients, illiterate patients Patients leaving the neurological SSR department prematurely Patients not affiliated to a social security scheme Pregnant or lactating women.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The investigators will evaluate the reorganization of functional and structural brain connectivity maps before and after rehabilitation of aphasia with art therapy and standard orthophonic rehabilitation versus a control group that received only standard orthophonic rehabilitation.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Art therapy<br>Art therapy and standard orthophonic rehabilitation | Other: Art therapy and standard orthophonic rehabilitation<br>* In addition to standard orthophonic rehabilitation, the patient will receive 12 sessions of art therapy<br>|
| No Intervention: Control group<br>Only standard orthophonic rehabilitation | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change from baseline measurement of white substance bundles volumes for structural connectivity at 6 weeks |  | from inclusion at 6 weeks | 
| change from baseline measurement of synchrony amplitude of slow fluctuations for functional Connectivity at 6 weeks |  | from inclusion at 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change from baseline Aphasia at 6 weeks | The BDAE (Boston Diagnostic Aphasia Examination) score ranges from 0 to 5, with higher values indicating more severe impairment | from inclusion at 6 weeks | 
| change from baseline Aphasia at 6 weeks | The ART (Aphasia Rapid Test) score ranges from 0 to 26, with higher values indicating more severe impairment | from inclusion at 6 weeks | 
| change from baseline Anxiety and depression at 6 weeks | The HADS (Hospital Anxiety and Depression Scale) scores ranges from 0 to 21 for both anxiety and depression scores, with higher values indicating more severe impairment | from inclusion and at 6 weeks | 
| change from baseline Quality of life self-assessment at 6 weeks | Visual Analogic scale of patient quality of life is a 0% to 100% scale, with 100 indicating the best health status | from inclusion at 6 weeks | 
| Satisfaction self-assessment at 6 weeks | visual analogic scale of patient satisfaction is a 0 to 10 scale, with higher values indicating better satisfaction | at 6 weeks only | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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brain connectivity, aphasia, art therapy, rehabilitation