Marie Di Pietro

Receptive amusia: temporal auditory processing deficit in a professional musician following a left temporo-parietal lesion

This study examined the musical processing in a professional musician who suffered from amusia after a left temporo-parietal stroke. The patient showed preserved metric judgement and normal performance in all aspects of melodic processing. By contrast, he lost the ability to discriminate or reproduce rhythms. Arrhythmia was only observed in the auditory modality: discrimination of auditorily presented rhythms was severely impaired, whereas performance was normal in the visual modality. Moreover, a length effect was observed in discrimination of rhythm, while this was not the case for melody discrimination. The arrhythmia could not be explained by low-level auditory processing impairments such as interval and length discrimination and the impairment was limited to auditory input, since the patient produced correct rhythmic patterns from a musical score. Since rhythm processing was selectively disturbed in the auditory modality, the arrhythmia cannot be attributed to a impairment of supra-modal temporal processing. Rather, our findings suggest modality-specific encoding of musical temporal information. Besides, it is proposed that the processing of auditory rhythmic sequences involves a specific left hemispheric temporal buffer.

Computerised treatment of anomia in acute aphasia: treatment intensity and training size.

In this study we analysed the outcome of computer-assisted therapy (CAT) for anomia on eight acute aphasic patients. Since therapy for anomia generally leads to an item-specific effect, the aim of the present study was to investigate whether it is possible to enhance recovery from anomia by increasing the number of treated items. Two periods of five daily written-naming CAT sessions were compared: In one period the CAT included one set of 48 words (single list) and in the other period a double list of 96 items was treated. Seven out of eight patients improved in naming performance for treated items. Overall gains were superior after practising the double list, despite fewer item repetitions. These results suggest that the size of the effect of therapy for anomia depends more on the number of treated items than on the number of repetitions per item. The integration of these results within the framework of studies on intensity is discussed.

Coherent neural oscillations predict future motor and language improvement after stroke

Recent findings have demonstrated that stroke lesions affect neural communication in the entire brain. However, it is less clear whether network interactions are also relevant for plasticity and repair. This study investigated whether the coherence of neural oscillations at language or motor nodes is associated with future clinical improvement. Twenty-four stroke patients underwent high-density EEG recordings and standardized motor and language tests at 2-3 weeks (T0) and 3 months (T1) after stroke onset. In addition, EEG and motor assessments were obtained from a second population of 18 stroke patients. The graph theoretical measure of weighted node degree at language and motor areas was computed as the sum of absolute imaginary coherence with all other brain regions and compared to the amount of clinical improvement from T0 to T1. At T0, beta-band weighted node degree at the ipsilesional motor cortex was linearly correlated with better subsequent motor improvement, while beta-band weighted node degree at Brocas area was correlated with better language improvement. Clinical recovery was further associated with contralesional theta-band weighted node degree. These correlations were each specific to the corresponding brain area and independent of initial clinical severity, age, and lesion size. Findings were reproduced in the second stroke group. Conversely, later coherence increases occurring between T0 and T1 were associated with less clinical improvement. Improvement of language and motor functions after stroke is therefore associated with inter-regional synchronization of neural oscillations in the first weeks after stroke. A better understanding of network mechanisms of plasticity may lead to new prognostic biomarkers and therapeutic targets.See Ward (doi:10.1093/brain/awv265) for a scientific commentary on this article.

Defective Spatial Imagery with Pure Gerstmann’s Syndrome

Gerstmann’s syndrome comprises finger agnosia, peripheral agraphia, anarithmetia, and right-left confusion. We here report a single-case study of an 85-year-old ambidextrous man who exhibited pure Gerstmann’s syndrome (i.e., without aphasia) 10 weeks after a stroke involving the angular gyrus in the left parietal lobe. We hypothesize that, in this case, the main cognitive denominator of Gerstmann’s tetrad was a severe dysfunction in mental rotation and translation. This report provides further evidence for the spatial nature of Gerstmann’s syndrome.

Computerised treatment of anomia in chronic and acute aphasia: An exploratory study

Background: Studies on computer assisted therapy (CAT) show encouraging outcomes with chronic aphasic speakers. However, there have been no studies investigating efficacy of CAT carried out with acute in-patients. Aims: This paper aims to evaluate the effects and feasibility of an unsupervised computer-based therapy for anomia in chronic out-patient and acute in-patient aphasic participants. The computerised training programmes were selected according to each participants anomic syndrome. Methods & Procedures: A multiple single-case design was used with two subgroups of aphasic participants. In the out-patients group (N = 4), CAT sessions were alternated with an equal number of clinical treatment sessions. In a second group of seven in-patients with acute aphasia, CAT was added to daily individual aphasia therapy. Outcomes & Results : In four chronic out-patients, a significant item-specific effect of CAT was shown. For two participants, this effect was similar to the effect of an equal number of individual clinical therapy sessions. Results were more heterogeneous in the in-patient group: an item-specific effect of CAT, not accounted for by spontaneous recovery, was observed in three of the seven participants. Conclusions: The present data suggest that individually adapted CAT can be effective as an adjunct to clinical therapy for anomia, not only with chronic aphasic out-patients but also in acute in-patients. Further investigation is needed in order to specify the conditions of application of CAT, given the varied results among our participants specially in the in-patients group.

The Neural Correlates of Object-Centered Processing in Reading: A Lesion Study of Neglect Dyslexia.

Neglect dyslexia--a peripheral reading disorder generally associated with left spatial neglect--is characterized by omissions or substitutions of the initial letters of words. Several observations suggest that neglect dyslexia errors are independent of viewer-centered coordinates; the disorder is therefore thought to reflect impairment at the level of object-centered representations. This hypothesis is indirectly supported by lesion studies connecting object-centered neglect errors with damage to posterior cortical regions lying in the ventral visual stream. Here, we performed a lesion-symptom mapping study of 40 patients with spatial neglect asked to read words presented at different positions relative to a viewer-centered coordinate frame. We found that the frequency of object-centered reading errors was constant across horizontal positions, whereas the frequency of entirely neglected words (reflecting a page-centered deficit) linearly increased from right to left. Damage to the intraparietal sulcus and the angular and middle temporal gyri was the best predictor of object-centered errors. We discuss these findings with reference to a role of the posterior parietal lobe in adapting the size of the attentional focus and biasing object representations elaborated in the ventral visual stream.

Two Intrinsic Coupling Types for Resting-State Integration in the Human Brain

Recent findings indicate that synchronous neural activity at rest influences human performance in subsequent tasks. Synchronization can occur in form of phase coupling or amplitude correlation. It is unknown whether these coupling types have differing behavioral significance at rest. To address this, we performed resting-state electroencephalography (EEG) and source connectivity analysis in several populations of healthy subjects and patients with brain lesions. We systematically compared different types and frequencies of neural synchronization and investigated their association with behavioral performance in verbal and spatial attention tasks. Behavioral performance could be consistently predicted by two distinct resting-state coupling patterns: (1) amplitude envelope correlation of beta activity between homologous areas of both hemispheres, (2) lagged phase synchronization in EEG alpha activity between a brain area and the entire cortex. A disruption of these coupling patterns was also associated with neurological deficits in patients with stroke lesions. This suggests the existence of two distinct network systems responsible for resting-state integration. Lagged phase synchronization in the alpha band is associated with global interaction across networks while amplitude envelope correlation seems to be behaviorally relevant for interactions within networks and between hemispheres. These two coupling types may therefore provide complementary insights on brain physiology and pathology.

Language and syntactic impairment following stroke in late bilingual aphasics

PURPOSE Bilingual aphasia generally affects both languages. However, the age of acquisition of the second language (L2) seems to play a role in the anatomo-functional correlation of the syntactical/grammatical processes, thus potentially influencing the L2 syntactic impairment following a stroke. The present study aims to analyze the influence of late age of acquisition of the L2 on syntactic impairment in bilingual aphasic patients. METHODS Twelve late bilingual participants (speaking French as L2 and either English, German, Italian or Spanish as L1) with stroke-induced aphasia participated in the study. The MAST or BAT aphasia batteries were used to evaluate overall aphasia score. An auditory syntactic judgement task was developed and used to test participants syntactic performance. RESULTS The overall aphasia scores did not differ between L1 and L2. In a multiple case analysis, only one patient had lower scores in L2. However, four patients presented significantly lower performances in syntactic processing in the late L2 than in their native language (L1). In these four patients the infarct was localized, either exclusively or at least partially, in the pre-rolandic region. CONCLUSION This pilot study suggests that, in late bilingual aphasics, syntactic judgment abilities may be more severely impaired in L2, and that this syntactic deficit is most likely to occur following anterior lesions.

What does recovery from anomia tell us about the underlying impairment: The case of similar anomic patterns and different recovery

Although word-finding difficulties have been largely studied from a theoretical and a rehabilitation point of view, recovery mechanisms and especially the fact that patients with similar anomic patterns may exhibit different recovery, are still not fully understood. In the first part of the present study we investigated the word retrieval curve during therapy and the psycholinguistic variables affecting word-finding recovery patterns in three anomic subjects (PG, AH and TM). Despite the fact that all patients had similar anomia at baseline, they presented different recovery patterns during an identical therapy program. The progress during therapy and the number of sessions necessary to reach satisfactory improvement was similar in two patients (AH and TM), but differed in the third patient (PG), who needed more treatment sessions. Moreover, these two different patterns were affected by different psycholinguistic variables: words age of acquisition predicted improvement in AH and TM, whereas phonological neighbourhood predicted improvement in PG. Following the observation that phonological neighbourhood density affected the slower progress during therapy, in the second study we analysed whether this variable also predicts pseudo-word learning in healthy controls and in anomic subjects. Indeed, phonological neighbourhood predicted pseudo-word learning speed in controls and in some anomic patients. We suggest that the analysis of progress during therapy for anomia and the comparison of the variables affecting learning and recovery may provide information about the underlying nature of the anomic deficit that is not available through the simple assessment of performance.

The Role of the Cognitive Control System in Recovery from Bilingual Aphasia: A Multiple Single-Case fMRI Study

Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1) and second (L2) language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming) in each language and language control (linguistic and nonlinguistic switching tasks), as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM) analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages.