Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation

Abstract

Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca's aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca's area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.

Embodied Semantics in a Second Language: Critical Review and Clinical Implications

“…In other words, the impact of L2 lexico-semantic processing on motor system has yet to be examined in brain-damaged populations. In monolinguals, some studies did look at the co-occurrence of language and motor impairment in developmental disorders (e.g., Hill, 2001; Sanjeevan et al, 2015) or brain-damaged patients (Desai et al, 2015; for a review see Anderlini et al, 2019).…”

“…In Maitra et al (2006), for example, patients that had suffered a stroke had their movements facilitated with self-speech (i.e., self-vocalization). As Anderlini et al (2019) suggest, the choice of the type of therapeutic approach should consider both the language and motor systems and how they interact, especially when motor and language impairments coexist.…”

Brain Metabolism but Not Gray Matter Volume Underlies the Presence of Language Function in the Minimally Conscious State (MCS): MCS+ Versus MCS− Neuroimaging Differences

“…Using a more conservative correction (ie, FWE), higher metabolism was identified in MCS+ compared with MCS− in the left middle temporal cortex, which has been associated to selective processing of speech, 26,27 semantic processing, 28,29 and word generation. 30 The FDR correction analysis also highlighted other language-related brain regions: the left angular gyrus, [31][32][33] the left middle frontal gyrus, [34][35][36][37][38] the left inferior frontal gyrus (pars opercularis), [39][40][41] the prefrontal and premotor cortex as well as supplementary motor area, 42 which are also involved in various motor functions. 43 These results are in line with previous research showing that the left middle temporal cortex and left angular gyrus could differentiate MCS subcategories at the subject level, 12 and that a preserved metabolism in these regions was associated with residual language comprehension in 3 postcoma patients.…”

Determinants of life satisfaction among stroke survivors 1 year post stroke

“…These findings are in line with multiple studies that have shown that verbal dysfunction (presentation of aphasia) is a predictive factor for functional recovery and LS. [ 74 – 76 ] Aphasia is a predicting factor of functional motor outcome [ 75 ] and has been reported as a significant predictor of emotional distress, [ 77 ] loneliness, and social isolation. [ 78 ]…”