Jacquie Kurland

Improved naming after TMS treatments in a chronic, global aphasia patient – case report

We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca’s homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming.

Overt naming in aphasia studied with a functional MRI hemodynamic delay design.

The purpose of this study was to develop a functional MRI method to examine overt speech in stroke patients with aphasia. An fMRI block design for overt picture naming was utilized which took advantage of the hemodynamic response delay where increased blood flow remains for 4-8 s after the task [(Friston, K.J., Jezzard, P., Turner, R., 1994. Analysis of functional MRI time-series. Hum. Brain Mapp. 1, 153-171)]. This allowed task-related information to be obtained after the task, minimizing motion artifact from overt speech (Eden, G.F., Joseph, J., Brown, H.E., Brown, C.P., Zeffiro, T.A., 1999. Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: the behavior interleaved gradients technique. Magn. Reson. Med. 41, 13-20; Birn, RM., Bandettini, P.A., Cox, R.W., Shaker, R., 1999. Event-related fMRI of tasks involving brief motion. Hum. Brain Mapp. 7, 106-114; Birn, R.M., Cox, R.W., Bandettini, P.A., 2004. Experimental designs and processing strategies for fMRI studies involving overt verbal responses. NeuroImage 23, 1046-1058). Five chronic aphasia patients participated (4 mild-moderate and 1 severe nonfluent/global). The four mild-moderate patients who correctly named 88-100% of the pictures during fMRI, had a greater number of suprathreshold voxels in L supplementary motor area (SMA) than R SMA (P < 0.07). Three of these four mild-moderate patients showed activation in R BA 45 and/or 44; along with L temporal and/or parietal regions. The severe patient, who named no pictures, activated almost twice as many voxels in R SMA than L SMA. He also showed activation in R BA 44, but had remarkably extensive L and R temporal activation. His poor naming and widespread temporal activation may reflect poor modulation of the bi-hemispheric neural network for naming. Results indicate that this fMRI block design utilizing hemodynamic response delay can be used to study overt naming in aphasia patients, including those with mild-moderate or severe aphasia. This method permitted verification that the patients were cooperating with the task during fMRI. It has application for future fMRI studies of overt speech in aphasia.

Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke's aphasia

Background: Renewed interest in the effects of intensity on treatment has led to development of short-term, intensive treatment protocols, such as Constraint-Induced Language Therapy (CILT), in which participants with chronic aphasia begin to show statistically significant language improvements in as little as 2 weeks. Given its relatively short treatment cycle, CILT is also a good choice of treatment methodology for studying brain/behaviour plasticity in post-stroke aphasia. Aims: This study aimed to examine differences between two short, intensive treatment protocols in a participant with chronic Wernickes aphasia both in terms of treatment outcomes and changes in patterns of BOLD signal activation. Methods & Procedures: The participant (ACL) participated in language testing and an fMRI overt speech confrontation-naming paradigm pre and post 2 weeks of CILT, post 2 weeks of unconstrained language therapy (PACE), and 6 months post-CILT. He named 48 black/white line drawings from each of four conditions: treated (CILT or PACE), untreated, or consistently correctly named pictures. Outcomes & Results: Naming treated pictures improved, even in the scanner, while naming untreated pictures did not. About one third of PACE and three-fourths of CILT gains were maintained. Rather than a distinct pattern of activation distinguishing treated from untreated or CILT from PACE pictures, ACL recruited a frontal network during naming of all pictures that included left middle and inferior frontal cortex, SMA and pre-SMA, and that varied in spatial extent and degree of activation according to accuracy and performance expectation. In post-hoc analyses of accuracy, this frontal network was most active during incorrect trials. At 6 months post-CILT, compared to controls, incorrect naming recruited a large and significant bilateral network including right Wernickes area homologue. Conclusions: Results suggest that short, intensive therapy can improve naming and jumpstart language recovery in chronic aphasia, whether responses are constrained to the speech modality or not. Modulation of a left frontal network was associated with accuracy in naming and may represent compensatory adaptation to improve response selection, self-monitoring, and/or inhibition.

Effects of cognate status and language of therapy during intensive semantic naming treatment in a case of severe nonfluent bilingual aphasia.

As bilingualism becomes less exceptional in the world, and with the growing incidence of stroke and aphasia, a better understanding of how bilingualism affects aphasia recovery is increasingly important. The present study examined the effect of intensive semantic naming therapy in three phases (Spanish, English and mixed) on within- and across-language generalization for cognates and non-cognates, in a bilingual individual with chronic, severe expressive aphasia. We hypothesized that cognates would positively influence cross-linguistic generalization, which might be more likely to occur from L2 to L1. Results indicate relative increases in confrontation naming ability in the following conditions: trained versus untrained, L1 versus L2 or mixed and non-cognates versus cognates. This participant demonstrated a pattern of results consistent with a differential recovery pattern in which presentation of treatment in both languages and training of cognates may have promoted interference, thus increasing the activation threshold, and lowering performance under these conditions.

Beyond Picture Naming: Norms and Patient Data for a Verb-Generation Task

PURPOSE In the current study, the authors aimed to (a) acquire a set of verb generation to picture norms; and (b) probe its utility as an outcomes measure in aphasia treatment. METHOD In Phase I, the verb-generation normative sample, 50 healthy volunteers generated verbs for 218 pictures of common objects (interstimulus interval = 5 s). In Phase II, 4 persons with aphasia (PWAs) generated verbs for 60 objects (interstimulus interval = 10 s). Their stimuli consisted of objects that were (a) recently trained (for object naming; n = 20), (b) untrained (a control set; n = 20), or (c) from a set of pictures named correctly at baseline (n = 20). Verb generation was acquired twice: once 2 months into and once following a 6-month home practice program. RESULTS No objects elicited perfect verb agreement in the normed sample. Stimuli with the highest percent agreement were mostly artifacts and dominant verbs primary functional associates. Although not targeted in treatment or home practice, PWAs mostly improved performance in verb generation postpractice. CONCLUSIONS A set of clinically and experimentally useful verb-generation norms was acquired for a subset of the Snodgrass and Vanderwart (1980) picture set. More cognitively demanding than confrontation naming, this task may help to fill the sizeable gap between object picture naming and propositional speech.

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILATs success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

Practice effects in healthy older adults: Implications for treatment-induced neuroplasticity in Aphasia

&NA; In treating aphasic individuals with anomia, practice naming pictures leads to better performance as measured by accuracy and reaction time. The neurocognitive mechanisms supporting such improvements remain elusive, in part due to gaps in understanding the influence of practice on neurotypical older adults. The current study investigated the influence of practice naming one set of low frequency pictures of actions and objects in 18 healthy older adults, ten of whom were tested twice approximately one month apart. Both item and task practice effects were observed in improved accuracy and response latencies naming pictures in the scanner. This same facilitation effect was observed in neuroimaging results. For example, a significant main effect of practice was observed in bilateral precuneus and left inferior parietal lobule, characterized by greater activity for naming practiced vs. unpracticed pictures. This difference was significantly diminished in subsequent runs after exposure to unpracticed pictures. Whole brain analyses across two sessions showed that practice effects were specific to practice, i.e., there were not similar observable changes in contrasts examining actions vs. objects over time. These findings have important implications for understanding treatment‐induced neuroplasticity in anomia treatment. HighlightsBrief practice naming pictures facilitates faster naming and changes in BOLD signal.Item and task practice effects are robust in healthy older individuals.Practice effects were observed in both LH language network ROIs and RH homologues.Effects on automatization may be separable from treatment‐induced neuroplasticity.

Let’s talk real talk: an argument to include conversation in a D-COS for aphasia research with an acknowledgment of the challenges ahead

Dietz and Boyle (this issue) present a compelling argument for the development of a core outcome set for discourse (D-COS) in aphasia research. As has been demonstrated repeatedly in other medically oriented research fields, and recently proposed by Wallace and colleagues for aphasia research (Wallace, Worrall, Rose, & Le Dorze, 2014), the development and use of a COS is likely to improve our ability to compare and synthesize experimental treatment outcomes and to increase transparency in the reporting of those outcomes. Dietz and Boyle argue forcefully for the principle of a D-COS, or subsets of D-COS geared toward the various levels of discourse analysis. As they reason, an abundance of tools for measuring discourse in aphasia has led to a tipping point, wherein the reliability and validity of some discourse measures are questionable, and the comparison of outcomes between treatment studies and systematic reviews of aphasia treatment research are difficult, if not impossible to conduct. We agree in principle with this view and, like the other participants at a recent Clinical Aphasiology Conference Round Table (Boyle & Dietz, 2015), who unanimously supported the establishment of a D-COS, we also recognize that it might nonetheless be a lofty goal. Dietz and Boyle acknowledge the potential difficulties, but may underestimate the challenges in this initial unveiling of the concept. Much like the impediments that need to be addressed to successfully implement the development of a COS, as Hula, Fergadiotis, and Doyle (2014) point out, establishment of a fruitful D-COS would have to overcome several obstacles, notably achievement of consensus on constructs to be measured both within the community of aphasia researchers and between all stakeholders. In fact, Hula and colleagues warn against a consensus-based process that risks codifying an unfocused, stale, or imperfect COS and that may fail to advance scientific progress or be adaptable to the many stakeholders. Moreover, MacWhinney (2014) also raises important considerations for overcoming the vast challenges of establishing and implementing a COS, among them, misjudging the complexity of the problem, and neglecting to integrate state-of-the-art methods for data-sharing and data archiving. All of the challenges facing development of an aphasia COS are also inherent in establishment of a D-COS. At the same time, developing a D-COS may be a first step in reducing the complexity of an aphasia COS, by offering a methodology for analyzing outcome subcomponents, i.e., those specifically related to discourse. Regardless of the

Erratum to “Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS” [Brain Lang. 111 (2009) 20–35]

Erratum to ‘‘Overt naming fMRI preand post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS” [Brain Lang. 111 (2009) 20–35] Paula I. Martin *, Margaret A. Naeser , Michael Ho , Karl W. Doron , Jacquie Kurland , Jerome Kaplan , Yunyan Wang , Marjorie Nicholas , Errol H. Baker , Miguel Alonso , Felipe Fregni , Alvaro Pascual-Leone b,c Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine and the Veterans Affairs Boston Healthcare System, USA Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA c Institut Guttmann, Barcelona, Spain