Recovery of language and theory of mind after stroke

中风后语言和心理理论的恢复

• 批准号: 10390577
• 负责人: MARGARET LEHMAN BLAKE
• 金额: $ 71.91万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390577
• 关键词: Acute; Address; Affect; Aphasia; Area; Attention; Behavioral; Behavioral Mechanisms; Brain; Brain Injuries; Brain region; Chronic; Cognitive deficits; Communication; Communication impairment; Comprehension; Country; Cues; Data; Dependence; Diagnosis; Emotional; Evolution; Facial Expression; Frequencies; Goals; Humor; Improve Access; Individual; Individual Differences; Inferior; Intervention; Knowledge; Laboratories; Language; Language Disorders; Lead; Left; Lesion; Life; Longitudinal Studies; Measures; Metaphor; Methods; Mind; Modeling; Neuropsychological Tests; Outcome; Parietal; Patients; Pattern; Probability; Production; Public Health; Quality of life; Recovery; Rehabilitation therapy; Right cerebral hemisphere; Sampling; Short-Term Memory; Social Interaction; Speech; Stroke; Structure; Symptoms; Testing; Time; acute stroke; behavior measurement; brain behavior; chronic stroke; cognitive ability; executive function; health care availability; improved; innovation; language comprehension; longitudinal analysis; neuroimaging; neuromechanism; patient population; post stroke; predictive modeling; recruit; relating to nervous system; social; social communication; social deficits; theories; tool; white matter

Project Summary Left and right hemisphere (RH) strokes occur at similar frequencies and both are associated with life-altering communication deficits. However, patients with RH stroke rarely receive speech-language intervention, likely because they do not present with obvious language deficits like aphasia. Instead, they have difficulties engaging in typical conversations which require understanding what a speaker means, especially when in opposition to what was actually said, such as occurs in sarcasm, humor and metaphors. A specific deficit in the ability to understand others’ perspectives and intended meanings, known as theory of mind (ToM) may be a primary cause of communication deficits and a critical component of differential recovery after RH stroke. Inappropriately responding during conversation due to misunderstandings of what a speaker knows and intends creates poor social interactions and negatively impacts relationships. For those living with RH stroke, communication deficits have profoundly damaging effects on quality of life. Our central hypothesis is that RH stroke causes discourse-level language deficits due to damage to brain areas critical to ToM, an essential component of social communication. Our goal is to assess language and ToM abilities from acute to chronic stages of RH stroke while collecting neuroanatomical and quality of life data. We will measure the contribution of other social deficits including the processing of emotional prosody and non-verbal cues (e.g., facial expressions) as well as cognitive deficits including working memory, executive function, and attention. To date, estimates of language and ToM deficits which occur after RH stroke and the relationship between them are inconsistent or unexplored. Most studies examine patients in rehabilitation settings who likely have large strokes and more severe communication disorders, creating a bias in our knowledge about the effects of stroke. The effects of damage to RH brain regions, their connections, and how they contribute to language recovery are also unknown, limiting decisions about treatment priorities. Lastly, whether language recovery depends on ToM is unknown as there are no longitudinal studies of communication recovery from acute RH stroke. We will address these gaps by examining individuals in a large group of acute stroke subjects, as they progress from acute to chronic stroke to evaluate the relationship between changes in language, ToM and their dependence on neural recovery. Our innovative approach combines recent advances in neuropsychological testing and neuroimaging analysis to provide converging causal evidence to validate a ToM theory of RH stroke communication. Aim 1 tests the hypothesis that language depends on intact ToM at the acute stage of stroke before functional reorganization. Aim 2 tests the hypothesis that language depends on ToM associated neural structures and connectivity acutely, before functional reorganization. Aim 3 examines recovery of language and relationships with ToM and brain structure by assessing behavioral and neural changes across the first year after stroke. Successful outcomes include understanding the behavioral and neural mechanisms underlying RH deficits, their evolution post-stroke, and their impact on quality of life. As a result, we will be able to develop better assessment and intervention tools, improving access to health care and long-term outcomes for this underserved patient population.

项目概要 左右半球 (RH) 中风发生的频率相似，并且都与改变生活有关 然而，RH 卒中患者很少接受言语干预，可能是因为 他们没有出现失语症等明显的语言缺陷，相反，他们在进行典型的活动时遇到困难。 需要理解说话者的意思的对话，尤其是与实际意思相反的时候 说，例如在讽刺、幽默和隐喻中出现的理解他人观点能力的特定缺陷。 和预期含义，即心理理论 (ToM)，可能是沟通缺陷的主要原因，也是造成沟通障碍的主要原因。 RH 中风后因谈话不当而导致恢复差异的关键因素。 对说话者的了解和意图的误解会造成不良的社交互动和负面影响 对于患有 RH 中风的人来说，沟通缺陷会对人际关系的质量产生深远的破坏性影响。 我们的中心假设是，RH 中风由于大脑区域受损而导致言语层面的语言缺陷。 对于 ToM 至关重要，它是社交沟通的重要组成部分，我们的目标是评估语言和 ToM 能力。 我们将测量 RH 中风的急性到慢性阶段，同时收集神经解剖学和生活质量数据。 其他社会缺陷的贡献，包括情感韵律和非语言线索的处理（例如面部表情） 表达）以及认知缺陷，包括工作记忆、执行功能和注意力。 对 RH 卒中后发生的语言和 ToM 缺陷的估计以及它们之间的关系不一致 或未经探索的大多数研究都检查了可能患有大中风和更严重中风的患者。 沟通障碍，导致我们对中风影响的认识存在偏差。 大脑区域、它们的连接以及它们如何促进语言恢复也是未知的，这限制了决策 最后，语言恢复是否取决于 ToM 尚不清楚，因为没有纵向关系。 我们将通过对大规模个体进行检查来解决这些差距。 一组急性中风受试者，当他们从急性中风进展为慢性中风时，以评估之间的关系 我们的创新方法结合了最新的语言、ToM 及其对神经恢复的依赖的变化。 神经心理学测试和神经影像分析的进展提供了一致的因果证据来验证 RH 中风交流的 ToM 理论目标 1 检验了语言在急性期依赖于完整 ToM 的假设。 目标 2 检验语言依赖于 ToM 相关的假设。 目标 3 检查语言和功能的恢复。 通过评估中风后第一年的行为和神经变化来研究 ToM 和大脑结构的关系。 成功的结果包括了解 RH 缺陷背后的行为和神经机制、其 中风后的演变及其对生活质量的影响因此，我们将能够进行更好的评估和评估。 干预工具，改善这一服务不足的患者群体获得医疗保健的机会和长期结果。