Therapy-Induced Plasticity in Chronic Aphasia Is Associated with Behavioral Improvement and Time Since Stroke.

Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 101550313 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2158-0022 (Electronic) Linking ISSN: 21580014 NLM ISO Abbreviation: Brain Connect Subsets: MEDLINE

Original Publication: New Rochelle, NY : Mary Ann Liebert, Inc.

Aphasia*/diagnostic imaging ; Aphasia*/etiology ; Aphasia*/physiopathology ; Aphasia*/therapy ; Cerebral Cortex*/diagnostic imaging ; Cerebral Cortex*/physiopathology ; Nerve Net*/diagnostic imaging ; Nerve Net*/physiopathology ; Stroke*/complications ; Stroke*/diagnostic imaging ; Stroke*/physiopathology ; Stroke*/therapy; Connectome/*methods ; Neuronal Plasticity/*physiology ; Speech Therapy/*methods; Adult ; Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Time Factors

Cortical reorganization after stroke is thought to underlie functional improvement. Patterns of reorganization may differ depending on the amount of time since the stroke or the degree of improvement. We investigated these issues in a study of brain connectivity changes with aphasia therapy. Twelve individuals with chronic aphasia participated in a 6-week trial of imitation-based speech therapy. We assessed improvement on a repetition test and analyzed effective connectivity during functional magnetic resonance imaging of a speech observation task before and after therapy. Using structural equation modeling, patient networks were compared with a model derived from healthy controls performing the same task. Independent of the amount of time since the stroke, patients demonstrating behavioral improvement had networks that reorganized to be more similar to controls in two functional pathways in the left hemisphere. Independent of behavioral improvement, patients with remote infarcts (2-7 years poststroke; n = 5) also reorganized to more closely resemble controls in one of these pathways. Patients with far removed injury (>10 years poststroke; n = 3) did not show behavioral improvement and, despite similarities to the normative model and overall network heterogeneity, reorganized to be less similar to controls following therapy in a distinct right-lateralized pathway. Behavioral improvement following aphasia therapy was associated with connectivity more closely approximating that of healthy controls. Individuals who had a stroke more than a decade before testing also showed plasticity, with a few pathways becoming less like controls, possibly representing compensation. Better understanding of these mechanisms may help direct targeted brain stimulation.

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R01 DC007488 United States DC NIDCD NIH HHS; R33 DC008638 United States DC NIDCD NIH HHS

Keywords: aphasia; effective connectivity; neuroplasticity; speech therapy; stroke recovery

Date Created: 20180118 Date Completed: 20190528 Latest Revision: 20240323

20240323

PMC5899281

10.1089/brain.2017.0508

29338310