Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

Abstract

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS.Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months.Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery.Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study

“…Hybbinette et al [ 27 ] confirmed the common occurrence of apraxia of speech and aphasia in left hemisphere stroke patients with a hand motor impairment through a small sample study. Our correlation analyses results show that the four dimensions of language function—spontaneous speech, comprehension, repetition, and naming—were all associated with UE motor status (see Figure 5 ).…”

Relationship between upper extremities functional recovery with speech recovery among post stroke patients - an observational study

“…This finding could be due to the fact that upper limb movements and speech are developed from adjoining areas of the brain and shares common anatomical network. 6,14,16 Furthermore, this result permits a possibility that recovery of arm function and speech follows a parallel approach.…”

“…They also concluded that recovery of speech-language and motor domains follows a parallel path, despite of severity, supporting the common recovery hypothesis that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. 6 However, few other studies contradicted this statement by concluding that there are no anatomical association among arm functions and language. 16 The present study was done to find the association between recovery of language and upper extremity function in post stroke patients.…”

“…However, most stroke survivors regain independent ambulation, plentiful fails to improve functional usage of their effected upper limb. 6 Sensory and motor systems, visuo-spatial perception, cognitive deficits, language and communication disorders can be the major impairments of stroke. 7 One of the most common problems for stroke survivors are impaired upper limb function.…”

Connectomics underlying motor functional outcomes in the acute period following stroke

“…A similar effect was also found following transcranial direct current stimulation over the motor cortex, which led to improved language outcomes (Meinzer et al, 2016 ). More recently, Hybbinette et al also demonstrated that similar mechanism of recovery may be involved in language and motor recovery post-stroke, further contributing to the so-termed “shared recovery hypothesis” (Hybbinette et al, 2021 ). While well-controlled studies examining this phenomenon are lacking, our findings may suggest either: functional compensation by the language system associated with better performance, or impaired connectivity within the language system manifesting in poor sensorimotor outcomes.…”