Compensatory Reorganization in Recovery from Aphasia after Stroke

Bruce Crosson, Ph.D.

Brain Rehabilitation Research Center Malcom Randall VA Medical Center and Department of Clinical & Health Psychology University of Florida Gainesville, Florida Only published work or work presented at meetings is included in these slides.

Collaborators

Rehabilitation Leslie Gonzalez Rothi, Ph.D.

Katherine S. Richards, M.S.

Christina E. Wierenga, M.S.

M. Allison Cato, Ph.D.

Flo Singletary, M.A.

Maribel Ciampiti, M.A.

Beth Holliway, M.A.

Amy Rodriguez, M.A.

Susan Leon, M.A.

Cynthia Beaulieu, Ph.D.

R. Bruce Parkinson, M.S.

Megan E. Gaiefsky, M.S.

Anastasia M. Raymer, Ph.D.

Lynn M. Maher, Ph.D.

Tim W. Conway, Ph.D.

NeuroImaging Richard W. Briggs, Ph.D.

Keith D. White, Ph.D.

Anna Bacon Moore, Ph.D.

Megan Gaiefsky, M.S.

Kaundinya Gopinath, Ph.D.

Tim W. Conway, Ph.D.

K. K. Peck, Ph.D.

David Soltysik, Ph.D.

Christina Milsted Michelle Benjamin, M.S.

Keith McGregor R. Bruce Parkinson, M.S.

Ashley Wabnitz Trista Perez Yu-ling Chang, M.S.

Ashley Orynich

Funding Sources

NIDCD #P50 DC03888 Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard Briggs Imaging Core PIs VA RR&D #F2182C Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core Coordinator VA RR&D #B3470S Bruce Crosson, PI (Research Career Scientist) VA RR&D #C2602V Anna Moore, PI (Research Career Development Award) VA RR&D ##B3480H Tim W. Conway, PI (Associate Investigator Award)

Reorganization of Language in Aphasia: Left or Right Hemisphere?

1. RECOVERY: Does reorganization of function occur primarily in perilesional cortex of the dominant hemisphere (left) or in the previously nondominant (right) hemisphere?

2. REHAB: Does rehabilitation influence the hemisphere to which language reorganizes?

Review from: Crosson, B. (in press). Functional neuroimaging of impaired language: Aphasia. In Hillary & DeLuca (eds.) Functional Neuroimaging in Clinical Populations. New York: Guilford.

RECOVERY REVIEW Conclusion #1

Good Recovery: small lesions, greater perilesional than right hemisphere reorganization Poor Recovery: large lesions, greater right-hemisphere than perilesional reorganization References: Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al., 1998; Perani et al., 2003; Rosen et al., 2000

F15 L Sentence Generation: 4 Patients with Syntactic Impairments M62 L R M10 L R M31 L R McGregor et al., POSTER: 11 – 12:30 Saturday R

RECOVERY REVIEW Conclusion #2

Shifts to right-hemisphere homologues of damaged left-hemisphere areas References: Blank et al., 2003; Calvert et al., 2000; Lazar et al., 2000; Thulborn, 1999; Weiller et al., 1995).

RECOVERY REVIEW Conclusion #3

Role of Intention / Attention Mechanisms in Reorganization

Anterior lesion with intact basal ganglia: Reorganization of language production to the right frontal lobe Anterior + basal ganglia lesion: Bilateral frontal activity during language production Reference: (Kim et al., 2002).

S01 Lesions: S01 and S02 S02

L L Crosson et al. (2005) Journal of Cognitive Neuroscience Caudate Putamen Thalamus

Activity (fMRI Task: Event-Related Word Generation) (Using Selective Detrending)

2000

S01: Basal Ganglia Lesion S02: No Basal Ganglia Lesion

1500 1000 Left Right 500 0

pre-SMA Lateral Frontal pre-SMA Lateral Frontal Crosson et al. (2005) Journal of Cognitive Neuroscience

REHABILITATION REVIEW Conclusion #1

Treatment outcome affected by lesion size and location

Correlations between Naming Improvement and Basal Ganglia Lesion Extent: Partial Correlations Controlling for Anterior Cortical Lesion Extent Object naming improvement vs. basal ganglia (N=13) r -.749

p .005

Action naming improvement vs. basal ganglia (N=12) -.785

.004

Parkinson et al., POSTER: 11 – 12:30 Saturday

Hypotheses about Basal Ganglia Basal ganglia involved in suppression of behavior / cognition Damaged anterior language production mechanisms produce noisy output, hampering production Intact basal ganglia suppress noisy output

Correlations between Naming Improvement and Cortical Lesion Extent: Partial Correlation Controlling for Basal Ganglia Lesion Extent Anterior lesion vs. object naming improvement (N=13) r .858

p <.0005

Anterior lesion vs. action naming improvement (N=12) .821

.002

Parkinson et al., POSTER: 11 – 12:30 Saturday

Critical Cortex Lesion Size and Perilesional Activity Large Lesion Chronic Aphasia Cases Perilesional Activity Impossible: R Hemisphere Best Substrate Perilesional Activity “Noisy” Competes with R Hemisphere Small Lesion Perilesional Reorganization Optimal: L Hemisphere Best Substrate

REHABILITATION REVIEW Conclusion #2

It may be possible to influence the hemisphere in which language functions are performed through treatment

00-008: Pre- and Post-Tx Images Frontal Activity

Before Training After Training RIGHT LEFT RIGHT LEFT Crosson et al. (2005) Journal of Cognitive Neuroscience

REHABILITATION REVIEW Conclusion #3

“Activity” during fMRI does not signify contribution to language It might even be detrimental References: Martin et al., 2004; Naeser et al., 2005; Rosen et al., 2000

REHABILITATION REVIEW Conclusion #4

Activity in right-hemisphere homologues of damaged left hemisphere language cortex can be critical for rehabilitation Reference: Musso et al., 1999

REHABILITATION REVIEW Conclusion #5

Reactivating intact left-hemisphere language cortex can also be critical in rehabilitation

Syntactic Mapping Treatment (fMRI Task: Active Sentence Generation from Picture) G01 Post-Treatment

G01 Outcome:

Improved word order in sentences with generalization to narrative sample G01 Pre-Treatment

X = -40 Medial Lateral X = -52

J02 Outcome:

Improved word order in sentences with no generalization to narrative sample J02 Pre-Treatment

X = -47 Medial X = -45

J02 Post-Treatment

X = -36 Medial Lateral X = -48 Medial Lateral Lateral X = -56 X = -54

Wierenga et al. (in press) Journal of the International

Neuropsychological Society

Phonological Rehabilitation (Nonsense Syllable Repetition) PRE POST Right Auditory BA 42 Left Auditory BA42 Chang et al., POSTER: 9 – 10:30 Friday

Take Home Messages

1. Both the left and right hemispheres participate in recovery from and rehabilitation for aphasia. The degree of right vs. left participation depends on the patient, the size of the lesion, the location of the lesion, and the language function in question.

2. It may be possible to manipulate intentional mechanisms to change the hemisphere from which language production is performed if that is desirable.

3. Activity in a structure (in the left or right hemisphere) during functional neuroimaging tasks does not mean it is making a positive contribution to performance.

Posters, bibliography, and slides of completed work at www.BIRC.phhp.ufl.edu