Compensatory Reorganization in Compensatory Reorganization in Recovery from Aphasia after StrokeRecovery from Aphasia after Stroke

Bruce Crosson, Ph.D.Bruce Crosson, Ph.D.

Brain Rehabilitation Research CenterBrain Rehabilitation Research CenterMalcom Randall VA Medical CenterMalcom Randall VA Medical Center

andandDepartment of Clinical & Health PsychologyDepartment of Clinical & Health Psychology

University of FloridaUniversity of FloridaGainesville, FloridaGainesville, Florida

Only published work or work presented at meetings is included in these slides.Only published work or work presented at meetings is included in these slides.

CollaboratorsCollaborators RehabilitationRehabilitationLeslie Gonzalez Rothi, Ph.D.Leslie Gonzalez Rothi, Ph.D.Katherine S. Richards, M.S.Katherine S. Richards, M.S.Christina E. Wierenga, M.S.Christina E. Wierenga, M.S.M. Allison Cato, Ph.D.M. Allison Cato, Ph.D.Flo Singletary, M.A.Flo Singletary, M.A.Maribel Ciampiti, M.A.Maribel Ciampiti, M.A.Beth Holliway, M.A.Beth Holliway, M.A.Amy Rodriguez, M.A.Amy Rodriguez, M.A.Susan Leon, M.A.Susan Leon, M.A.Cynthia Beaulieu, Ph.D.Cynthia Beaulieu, Ph.D.R. Bruce Parkinson, M.S.R. Bruce Parkinson, M.S.Megan E. Gaiefsky, M.S.Megan E. Gaiefsky, M.S.Anastasia M. Raymer, Ph.D.Anastasia M. Raymer, Ph.D.Lynn M. Maher, Ph.D.Lynn M. Maher, Ph.D.Tim W. Conway, Ph.D.Tim W. Conway, Ph.D.

NeuroImagingNeuroImagingRichard W. Briggs, Ph.D.Richard W. Briggs, Ph.D.Keith D. White, Ph.D.Keith D. White, Ph.D.Anna Bacon Moore, Ph.D.Anna Bacon Moore, Ph.D.Megan Gaiefsky, M.S.Megan Gaiefsky, M.S.Kaundinya Gopinath, Ph.D.Kaundinya Gopinath, Ph.D.Tim W. Conway, Ph.D.Tim W. Conway, Ph.D.K. K. Peck, Ph.D.K. K. Peck, Ph.D.David Soltysik, Ph.D.David Soltysik, Ph.D.Christina MilstedChristina MilstedMichelle Benjamin, M.S.Michelle Benjamin, M.S.Keith McGregorKeith McGregorR. Bruce Parkinson, M.S.R. Bruce Parkinson, M.S.Ashley WabnitzAshley WabnitzTrista PerezTrista PerezYu-ling Chang, M.S.Yu-ling Chang, M.S.Ashley OrynichAshley Orynich

Funding SourcesFunding Sources

NIDCD #P50 DC03888NIDCD #P50 DC03888Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard

Briggs Imaging Core PIsBriggs Imaging Core PIs

VA RR&D #VA RR&D #F2182CF2182CLeslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core

CoordinatorCoordinator

VA RR&D #VA RR&D #B3470SB3470S Bruce Crosson, PI (Research Career Scientist)Bruce Crosson, PI (Research Career Scientist)

VA RR&D #C2602V VA RR&D #C2602V Anna Moore, PI (Research Career Development Award)Anna Moore, PI (Research Career Development Award)

VA RR&D ##B3480HVA RR&D ##B3480HTim W. Conway, PI (Associate Investigator Award)Tim W. Conway, PI (Associate Investigator Award)

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

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

Reorganization of Language in Aphasia:Reorganization of Language in Aphasia:Left or Right Hemisphere?Left or Right Hemisphere?

Review from: Crosson, B. (in press). Functional neuroimaging of

impaired language: Aphasia. In Hillary & DeLuca (eds.) Functional Neuroimaging in Clinical Populations. New York: Guilford.

Good RecoveryGood Recovery: small lesions, greater perilesional than right-: small lesions, greater perilesional than right-hemisphere reorganization hemisphere reorganization

Poor RecoveryPoor Recovery: large lesions, greater right-hemisphere than : large lesions, greater right-hemisphere than perilesional reorganization perilesional reorganization

ReferencesReferences: Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al., : Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al.,

1998; Perani et al., 2003; Rosen et al., 20001998; Perani et al., 2003; Rosen et al., 2000

RECOVERY REVIEWRECOVERY REVIEWConclusion #1Conclusion #1

F15

M10

M62

M31

L

R

L

R

L

R

L

R

Sentence Generation: 4 Patients with Syntactic ImpairmentsSentence Generation: 4 Patients with Syntactic Impairments

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

Shifts to right-hemisphere homologues of damaged left-hemisphere Shifts to right-hemisphere homologues of damaged left-hemisphere areas areas

ReferencesReferences:: Blank et al., 2003; Calvert et al., 2000; Lazar et al., Blank et al., 2003; Calvert et al., 2000; Lazar et al.,

2000; Thulborn, 1999; Weiller et al., 1995).2000; Thulborn, 1999; Weiller et al., 1995).

RECOVERY REVIEWRECOVERY REVIEWConclusion #2 Conclusion #2

Role of Intention / Attention Mechanisms in ReorganizationRole of Intention / Attention Mechanisms in Reorganization

Anterior lesion with intact basal ganglia:Anterior lesion with intact basal ganglia: Reorganization of language Reorganization of language production to the right frontal lobe production to the right frontal lobe

Anterior + basal ganglia lesion:Anterior + basal ganglia lesion: Bilateral frontal activity during Bilateral frontal activity during language production language production

ReferenceReference: (Kim et al., 2002).: (Kim et al., 2002).

RECOVERY REVIEWRECOVERY REVIEWConclusion #3 Conclusion #3

Caudate

Putamen

Thalamus

L L

S01 S02

Lesions: S01 and S02Lesions: S01 and S02

Crosson et al. (2005) Journal of Cognitive Neuroscience

0

500

1000

1500

2000

pre-SMA LateralFrontal

pre-SMA LateralFrontal

Left

Right

Act

ivity

Vol

ume

(mic

rolit

ers)

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

Crosson et al. (2005) Journal of Cognitive Neuroscience

S01: BasalGangliaLesion

S02: No Basal Ganglia Lesion

Treatment outcome affected by lesion size and locationTreatment outcome affected by lesion size and location

REHABILITATION REVIEWREHABILITATION REVIEWConclusion #1 Conclusion #1

 

.004.004

-.749-.749 .005.005

-.785-.785

rr pp

Object naming improvement vs. basal Object naming improvement vs. basal ganglia (N=13)ganglia (N=13)

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

Correlations between Naming ImprovementCorrelations between Naming Improvementand Basal Ganglia Lesion Extentand Basal Ganglia Lesion Extent::

Partial Correlations Controlling for Anterior Cortical Lesion ExtentPartial Correlations Controlling for Anterior Cortical Lesion Extent

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

Hypotheses about Basal GangliaHypotheses about Basal Ganglia

Basal ganglia involved in suppression of behavior / cognition Basal ganglia involved in suppression of behavior / cognition

Damaged anterior language production mechanisms produce Damaged anterior language production mechanisms produce noisy output, hampering productionnoisy output, hampering production

Intact basal ganglia suppress noisy outputIntact basal ganglia suppress noisy output

 

rr pp

Anterior lesion vs. Anterior lesion vs. object naming object naming improvement (N=13)improvement (N=13)

.858.858 <.0005<.0005

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

.821.821 .002.002

Correlations between Naming Improvement and Cortical Lesion Extent:Correlations between Naming Improvement and Cortical Lesion Extent:Partial Correlation Controlling for Basal Ganglia Lesion ExtentPartial Correlation Controlling for Basal Ganglia Lesion Extent

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

Small LesionSmall Lesion

Perilesional Reorganization Optimal:Perilesional Reorganization Optimal:L Hemisphere Best SubstrateL Hemisphere Best Substrate

Perilesional Activity “Noisy”Perilesional Activity “Noisy”Competes with R HemisphereCompetes with R Hemisphere

Perilesional Activity Impossible:Perilesional Activity Impossible:R Hemisphere Best SubstrateR Hemisphere Best Substrate

Critical Cortex Lesion Size and Perilesional ActivityCritical Cortex Lesion Size and Perilesional Activity

ChronicAphasiaCases

Large LesionLarge Lesion

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

REHABILITATION REVIEWREHABILITATION REVIEWConclusion #2 Conclusion #2

Before Training After Training

RIGHT LEFT RIGHT LEFT

00-008: Pre- and Post-Tx Images00-008: Pre- and Post-Tx ImagesFrontal ActivityFrontal Activity

Crosson et al. (2005) Journal of Cognitive Neuroscience

““Activity” during fMRI does not signify contribution to language Activity” during fMRI does not signify contribution to language

It might even be detrimental It might even be detrimental

ReferencesReferences: Martin et al., 2004; Naeser et al., 2005; Rosen et al., : Martin et al., 2004; Naeser et al., 2005; Rosen et al., 20002000

REHABILITATION REVIEWREHABILITATION REVIEWConclusion #3 Conclusion #3

Activity in right-hemisphere homologues of damaged left-Activity in right-hemisphere homologues of damaged left-hemisphere language cortex can be critical for rehabilitationhemisphere language cortex can be critical for rehabilitation

ReferenceReference: Musso et al., 1999: Musso et al., 1999

REHABILITATION REVIEWREHABILITATION REVIEWConclusion #4 Conclusion #4

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

REHABILITATION REVIEWREHABILITATION REVIEWConclusion #5 Conclusion #5

G01 Pre-Treatment

J02 Pre-Treatment

G01 Post-Treatment

J02 Post-Treatment

Lateral

Medial

X = -52

X = -40

X = -45

X = -36

X = -56

X = -47

X = -54

X = -48

Lateral

Medial

Lateral

Medial

Lateral

Medial

G01 Outcome:G01 Outcome:Improved word order Improved word order in sentences with in sentences with generalization to generalization to narrative samplenarrative sample

J02 Outcome:J02 Outcome:Improved word order Improved word order in sentences with no in sentences with no generalization to generalization to narrative samplenarrative sample

Syntactic Mapping TreatmentSyntactic Mapping Treatment(fMRI Task: Active Sentence Generation from Picture)(fMRI Task: Active Sentence Generation from Picture)

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

Neuropsychological Society

PRE POSTPRE POST

RightRightAuditoryAuditoryBA 42BA 42

LeftLeftAuditoryAuditoryBA42BA42

Chang et al., POSTER: 9 – 10:30 Friday

Phonological Rehabilitation (Nonsense Syllable Repetition)Phonological Rehabilitation (Nonsense Syllable Repetition)

Take Home MessagesTake Home Messages

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

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

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

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