The Role of the Right Hemisphere in Recovery from Aphasia. Two Case Studies

Basso, Anna; Gardelli, Maurizia; Grassi, Maria Pia; Mariotti, Marita

doi:10.1016/s0010-9452(89)80017-6

Cited by 138 publications

(87 citation statements)

References 25 publications

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“…Since the 1870's, some reports have suggested that the RH can support some recovery of language after LH stroke (Barlow, 1877;Basso, Gardelli, Grassi, & Mariotti, 1989;Gowers, 1886;Kinsbourne, 1971). Some functional imaging studies have observed RH activation during different language tasks in a variety of aphasia patients.…”

Section: Introductionmentioning

confidence: 99%

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Martin

Naeser

et al. 2007

Brain and Language

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Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre-and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received ten, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a 'good responder' with improved naming and phrase length; P2 was a 'poor responder' without improved naming.Pre-TMS (10 yr. poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named. At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p<.02; p<.05, respectively). At 16 mo. there was also greater activation in L than R SMA (p<.08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14-18 pictures, post-TMS (2 mo. to 43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from 3 words pre-TMS, to 5-6 words post-TMS.Pre-TMS (1.5 yr. poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at 1 word, post-TMS.Lesion site may play a role in each patient's fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia. NIH Public Access

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Section: Introductionmentioning

confidence: 99%

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Martin

Naeser

et al. 2007

Brain and Language

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“…[7][8][9][10] Patients with small left hemisphere lesions may recruit perilesional areas with some involvement of right hemisphere homotops, 7,8,[11][12][13] while recovery for those with larger left lesions may occur entirely via the right hemisphere. [14][15][16][17][18][19][20][21] However, some studies have suggested right hemisphere remodeling as a maladaptive mechanism or epiphenomenon. 22,23 In the current study, we examine the contribution of the right hemisphere to fluency recovery by relating white matter integrity of right speech-motor homotops and the corpus callosum (CC) to a patient's arcuate fasciculus (AF) lesion load (LL) and chronic speech fluency measures.…”

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confidence: 99%

Right hemisphere structures predict poststroke speech fluency

et al. 2016

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Objective: We sought to determine via a cross-sectional study the contribution of (1) the right hemisphere's speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia.Methods: Fractional anisotropy (FA) of white matter regions underlying the right middle temporal gyrus (MTG), precentral gyrus (PreCG), pars opercularis (IFGop) and triangularis (IFGtri) of the inferior frontal gyrus, and the corpus callosum (CC) was correlated with speech fluency measures. A region within the superior parietal lobule (SPL) was examined as a control. FA values of regions that significantly predicted speech measures were compared with FA values from healthy ageand sex-matched controls.

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“…Evidence from patient data also supports this 'map extension' (Thompson, 2000a) with reports of renewed language impairments in people with aphasia with previously recovered language function, but who go on to experience a second left hemisphere stroke (Basso, Gardelli, Grassi, & Mariotti, 1989). Neuroimaging studies have also demonstrated activation of perilesional tissue adjacent to the lesioned area in response to language processing (Heiss, Kessler, Thiel, Ghaemi, & Karbe, 1999;Kurland et al, 2004;Warburton, Price, Swinburn, & Wise, 1999).…”

Section: Stages Of Recoverysupporting

confidence: 58%

“…As far back as 1877, Barlow demonstrated a transference from typical language centres to the right hemisphere (as cited in Crosson et al, 2007). Furthermore, patients with recovered language function following a left hemisphere stroke have been shown to experience a relapse after experiencing new right hemisphere damage (Basso et al, 1989;Thompson & den Ouden, 2008).…”

Section: Stages Of Recoverymentioning

confidence: 96%

Neurophysiological Markers of Language Recovery in Subacute Stroke

Roxbury¹

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Most patients with aphasia recover language function to some degree, but there is significant variability in the speed, nature, and extent of language recovery that occurs in the months following a stroke. Currently, there is no effective method available to predict how an individual with aphasia will recover. The most accurate predictors of recovery to date rely on global outcome measures which do not provide relevant information regarding recovery of symptoms that are targeted in therapy. The overall goal of this thesis was to examine whether language-related brain activity predicted recovery of specific symptoms in aphasia. The first aim was to gain a clearer understanding of the neural mechanisms which underpin word processing in healthy individuals.Brain activity associated with spoken word processing was investigated firstly in a group of healthy young adults, then in a healthy older cohort in order to ascertain whether task performance was preserved in ageing and if so, whether a preserved performance was underpinned by age-related changes in the neural mechanisms. The second main aim was to investigate the neural substrates which underpin language processing in the subacute (2-6 weeks) and chronic (6 months) phases of aphasia recovery and to determine whether the timing and extent to which these mechanisms are recruited contributes to a good or poor language outcome. An auditory lexical decision task with a novel pseudoword condition was employed to investigate language recovery mechanisms and was selected to ensure that patients with aphasia in the subacute stage would be able to perform the task with sufficient accuracy. The real word stimuli consisted of concrete and abstract items. The stimuli were presented in an event-related fMRI task to young healthy controls, older healthy controls, and patients with aphasia during the subacute and chronic phases post-stroke. A range of behavioural language measures was administered to all three cohorts and at both time points for patients with aphasia.In the healthy young group, concrete words elicited increased activity in a widely distributed network of brain regions including bilateral angular gyrus (AG), left posterior cingulate and left dorsolateral prefrontal cortex, compared to abstract words. Meanwhile, no region showed increased activity for abstract compared to concrete words, rather differences were only observed in bilateral AG when abstract words were contrasted with pseudowords. In the healthy older group, region of interest (ROI) results identified that a preserved performance was associated with an altered pattern of left hemisphere activity in the inferior and middle frontal regions, the AG and the fusiform gyrus.Differences between the healthy older and healthy young group were identified in key language regions, with the left inferior frontal gyrus (IFG) showing increased activity for abstract and pseudowords compared to concrete words while increased activity in the left AG was observed in the younger group only.ii In patients with a...

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The Role of the Right Hemisphere in Recovery from Aphasia. Two Case Studies

Cited by 138 publications

References 25 publications

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Right hemisphere structures predict poststroke speech fluency

Neurophysiological Markers of Language Recovery in Subacute Stroke

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