Brain Connectivity Supporting Language Recovery in Aphasia

大脑连接支持失语症的语言恢复

• 批准号: 8748269
• 负责人: Leonardo F Bonilha
• 金额: $ 35.04万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-10 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8748269
• 关键词: Advocate; Affect; Anomia; Aphasia; Aphasiology; Area; Behavioral; Biological Preservation; Brain; Brain Injuries; Brain Mapping; Cerebral cortex; Chronic; Clinical; Counseling; Data; Diffusion Magnetic Resonance Imaging; Disease; Employee Strikes; Exhibits; Goals; Image; Impairment; Injury; Interruption; Language; Last Name; Left; Left cerebral hemisphere; Lesion; Location; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measures; Methodology; Methods; Names; Necrosis; Necrotic Lesion; Neurologist; Neurology; Outcome; Pathologist; Patients; Persons; Play; Positioning Attribute; Predictive Value; Process; Quality of life; Recovery; Recruitment Activity; Rehabilitation therapy; Research Infrastructure; Retrieval; Role; Semantics; Severities; Speech; Speech Therapy; Statistical Models; Stroke; Structure; Techniques; Temporal Lobe; Testing; Treatment Effectiveness; Treatment outcome; United States; Work; alternative treatment; base; behavior measurement; cost effective; disability; frontal lobe; gray matter; improved; instrument; language processing; lexical; multidisciplinary; neurobiological mechanism; neuroimaging; phonology; prevent; prospective; public health relevance; relating to nervous system; tool; treatment trial; white matter

DESCRIPTION (provided by applicant): Aphasia, an impairment in language processing, is a common disorder associated with stroke. The hallmark deficit of aphasia is the inability to name objects or people (anomia). Many patients with chronic aphasia can improve with naming therapy, but treatment is not universally effective. If the reason for differences in treatment effectiveness were better understood, an instrument could be developed to identify the patients who have the greatest potential to improve. Furthermore, a better understanding of the predictors for language recovery could provide crucial information about the mechanisms supporting brain plasticity during rehabilitation. Our group has previously demonstrated that naming improvements due to therapy are primarily associated with functional modulation of the cerebral cortex in the left hemisphere. It follows that structural damage to cortical regions in th left hemisphere is a limiting factor for recovery. Nonetheless, preservation of the cerebral cortex cannot fully predict therapy-induced recovery. Some patients with apparently intact cortical structures are not able to recruit these areas during therapy and fail to improve. This apparent inconsistency may be related to limitations in brain mapping techniques and our hitherto inability to define the extent and location of brain damage after stroke. Specifically, cortical regions may be disconnected as a result of white matter loss. Conventional assessment tools underappreciate cortical disconnection, but it likely plays an important role in naming recovery because it prevents recruitment of spared cortical areas during therapy. With new methodological improvements in brain mapping, this hypothesis can be directly tested. It is now possible to chart neural connections in the entire brain (the brain connectome) using magnetic resonance diffusion tensor imaging. For this project, we developed optimized connectome-mapping techniques to assess neural connectivity in patients with aphasia due to a previous stroke. We aim to investigate the impacts of cortical necrosis and cortical disconnection on chronic naming impairments and treatment-induced naming recovery. This proposal leverages high-quality imaging and behavioral data from a large prospective treatment trial in aphasia to accomplish our goals in a cost-effective manner. We will assess specific regions in the left hemisphere that have been associated with lexical-semantic retrieval and phonological processing during naming. We will also create a clinical scale for the prediction of treatment outcome based on a personalized assessment of cortical damage and cortical connectivity, advocating for each patient to be treated according to their individualized brain network profile.

描述（由申请人提供）：语言处理中的障碍是失语症，是与中风相关的常见疾病。失语症的标志性赤字是无法命名对象或人（异常）。许多慢性失语症患者可以通过命名疗法改善，但治疗并非普遍有效。如果更好地理解治疗效率差异的原因，可以开发一种工具来确定具有最大改善潜力的患者。此外，对语言恢复的预测指标的更好理解可以提供有关支持脑恢复过程中大脑可塑性的机制的重要信息。我们的小组先前已经证明，由于治疗而命名的改进主要与左半球大脑皮层的功能调节有关。因此，左半球对皮质区域的结构损害是恢复的限制因素。但是，保存大脑皮层 无法完全预测治疗引起的康复。一些看似完整的皮质结构的患者在治疗过程中无法招募这些区域，并且无法改善。这种明显的不一致可能与大脑映射技术的局限性以及我们迄今无法定义中风后脑损伤的程度和位置有关。具体而言，由于白质损失，皮层区域可能会断开连接。常规的评估工具不足以使皮质断开连接，但它可能在命名恢复中起着重要作用，因为它可以防止治疗过程中富裕的皮质区域招募。随着大脑映射的新方法学改进，可以直接检验该假设。现在可以使用磁共振扩散张量成像来绘制整个大脑（大脑连接组）中的神经连接。对于这个项目，我们开发了优化的连接映射技术，以评估由于先前中风而失语症患者的神经连通性。我们旨在研究皮质坏死和皮质断开对慢性命名障碍和治疗引起的命名恢复的影响。该建议利用大型前瞻性治疗试验中的高质量成像和行为数据，以具有成本效益的方式实现我们的目标。我们将评估左半球的特定区域，这些区域与命名过程中词汇 - 语义检索和语音处理有关。我们还将基于对皮质损伤和皮质连通性的个性化评估来预测治疗结果的临床量表，并主张每个患者根据其个性化的大脑网络概况进行治疗。