Regression of Poststroke Aphasia and Concomitant Nonspeech Syndromes Due to Courses of Restorative Therapy Including Intensive Speech Therapy
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Objectives. To analyze clinical indicators and fMRI parameters associated with the therapeutic efficacy of courses of complex restorative therapy including intensive speech therapy in various clinical forms and severities of aphasia syndrome. Materials and methods. A total of 40 right-handed patients with aphasia syndrome were studied three months after disease onset before and after courses of therapy (4.7 weeks) including intensive speech therapy (15 h/week). The efficacy of courses of treatment and cognitive rehabilitation was assessed using changes in measures of neuropsychological, neurological, and neuroimaging investigations before and after patients received treatment. The extents of restoration of speech and nonspeech cognitive functions were evaluated (using a 10-point assessment of cognitive functions addressing changes in focal deficit (NIHSS), and patients’ functional recovery (Barthel index, modified Rankin scale). Neuroimaging methods included structural MRI, fMRI at rest, and the fMRI equivalent of the mismatch negativity (MMN) component of event-related potentials using a sequence of standard and deviant sounds (Russian-language phonemes) to obtain the MMN equivalent. A program written in Python 3.6.0 was used. Results. The greatest efficacy of courses of restorative therapy (≥15% improvement on subtests of the quantitative assessment scale) was seen in 28 cases (70%): 18 patients with initially severe and 10 patients with moderate aphasia (independently of the clinical type of aphasia) and in all 11 patients with isolated sensory aphasia. Regression of sensory aphasia was accompanied by marked activation of the intact speech homologs of the right hemisphere and the appearance of a low-volume, low-intensity activation of the left temporal-parietal area, with a near-normal location. Regardless of the clinical form of aphasia, maximum therapeutic efficacy was associated with reorganization of the speech-related resting neural network, including increases in both intrahemisphere and interhemisphere functional connectivity, with increases in intrahemisphere interactions between the posterior speech zones in the left hemisphere on the background of decreases in their interhemisphere connectivity. Statistically significant improvements in motor and sensory functions were seen in nine patients with moderate contralateral spastic hemiparesis (22%) (p ≤ 0.00), which did not correlate with the level of regression of speech and nonspeech impairments. A minor therapeutic effect was seen in 12 patients (30%) with mild and moderate speech and nonspeech cognitive impairments which did not correlate with any particular clinical form of aphasia. Conclusions. Courses of restorative hospital treatment lasting 4.7 weeks including intensive speech therapy (15 sessions per week) were maximally effective mainly in severe aphasia, as well as in a defined clinical form – isolated sensory aphasia. fMRI data identified a different compensatory reorganization of the neural speech network probably reflecting the features of poststroke neuroplasticity associated with regression of both severe speech impairments and a particular clinical form of aphasia.
Keywordsischemic stroke poststroke aphasia severity of aphasia clinical form of aphasia nonspeech cognitive impairments intensive speech therapy poststroke plasticity
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- 1.E. S. Bein and P. A. Ovcharova, Clinical Features and Treatment of Aphasia, Medicine and Physiculture, Sofia (1970).Google Scholar
- 2.A. R. Luriya, Higher Cortical Functions of Humans, Piter, St. Petersburg (2008).Google Scholar
- 3.L. S. Tsvetkova, Aphasiology. Current Challenges and Approaches to Their Solution, MPSI MODEK, Moscow (2011).Google Scholar
- 4.E. Plowman, B. Hentz, and C. Ellis, Jr., “Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors,” J. Eval. Clin. Pract., 18, No. 3, 689–694 (2012), https://doi.org/ https://doi.org/10.1111/j.1365-2753.2011.01650.
- 5.A. C. Laska, A. Hellblom, V. Murray, et al., “Aphasia in acute stroke and relation to outcome,” J. Int. Med., 249, No. 5, 413–422 (2001), https://doi.org/ https://doi.org/10.1046/j.1365-2796.2001.00812.
- 7.V. M. Shklovskij, “Neurorehabilitation of patients with the sequelae of stroke and craniocerebral trauma,” Zh. Nevrol. Psikhiatr., 115, No. 3, 75–81 (2015).Google Scholar
- 8.N. A. Shamalov, “Reperfusion therapy in ischemic stroke in the Russian Federation: Challenges and perspectives,” Nevrol. Neiropsikh. Psikhosom., 6, No. 2, 15–22 (2014).Google Scholar
- 9.E. C. Jauch and H. P. Saver, “Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association,” Stroke, 44, No. 3, 870–947 (2013), https://doi.org/ https://doi.org/10.1161/STR.0b013e318284056a.PubMedPubMedCentralGoogle Scholar
- 13.J. Greener, P. Enderby, and R. Whurr, “Pharmacological treatment for aphasia following stroke,” Cochrane Database Syst. Rev., 4, CD000424 (2001), https://doi.org/ https://doi.org/10.1002/14651858.CD000424.
- 14.C. Breitenstein, T. Grewe, A. Floel, et al., the FCET2EC study group, “Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting,” Lancet, 389, No. 10078, 1528–1538 (2017), https://doi.org/ https://doi.org/10.1016/S0140-6736(17)30067-3.Google Scholar
- 15.S. K. Bhogal, R. Teasell, and M. Speechley, “Intensity of aphasia therapy, impact on recovery,” Stroke, 34, No. 4, 987–993 (2003), https://doi.org/ https://doi.org/10.1161/01.STR.0000062343.64383.D0.PubMedGoogle Scholar
- 16.M. C. Brady, H. Kelly, J. Godwin, et al., “Speech and language therapy for aphasia following stroke,” Cochrane Database Syst. Rev., 6, СD000425:1-398 (2016), https://doi.org/ https://doi.org/10.1002/14651858.
- 17.A. Baumgaertner, T. Grewe, W. Ziegler, et al., “FCET2EC (From controlled experimental trial to =2 everyday communication, How effective is intensive integrative therapy for stroke-induced chronic aphasia under routine clinical conditions? A study protocol for a randomized controlled trial,” Trials, 14, 308 (2013), https://doi.org/ https://doi.org/10.1186/1745-6215-14-308.PubMedPubMedCentralGoogle Scholar
- 19.L. S. Tsvetkova, Recovery of Higher Mental Functions, Academic Project, Moscow (2004).Google Scholar
- 20.L. S. Tsvetkova, Aphasia and Restorative Training: Textbook, Moscow Psychosocial Institute, Moscow; MODEK, Voronezh (2005).Google Scholar
- 21.E. A. Narodova, S. V. Prokopenko, V. V. Narodova, and A. A. Narodov, “Rehabilitation of patients with complex motor aphasia in the acute period of ischemic stroke,” Vestn. Nov. Med. Tekhnol., 1, 40 (2012).Google Scholar
- 22.E. S. Berdnikovich, O. S. Orlova, and N. V. Shakhparonova, “Restoration of speech in patients with sensorimotor aphasia in the acute and early periods of stroke using sensory stimulation,” Golos i Rech, 2, 29–42 (2013).Google Scholar
- 23.V. M. Shklovskij and V. Ya. Repin, A Means of Assessing the Efficacy of Therapeutic Rehabilitation Measures in Patients with Impairments to Higher Mental Functions in Focal Lesions of the Brain, Moscow Research Institute of Psychiatry, Moscow (2006).Google Scholar
- 24.A. R. Luriya, Basic Neuropsychology, Moscow University Press, Moscow (1973).Google Scholar
- 25.L. S. Tsvetkova, T. V. Akhutina, and N. M. Pylaeva, A Method for Assessing Speech in Aphasia, Moscow State University, Moscow (1981).Google Scholar
- 27.F. Mahoney and D. Barthel, “Functional evaluation: the Barthel Index,” Md. Med. J., 14, 61–65 (1965).Google Scholar
- 28.N. Patel, V. A. Rao, E. R. Heilman-Espinoza, et al., “Simple and reliable determination of the modified Rankin scale score in neurosurgical and neurological patients: the mRS-9Q,” Neurosurgery, 71, No. 5, 971–975; discussion 975 (2012), https://doi.org/ https://doi.org/10.1227/NEU.0b013e31826a8a56.PubMedGoogle Scholar
- 32.K. J. Friston, A. P. Holmes, and K. J. Worsley, “Statistical parametric maps in functional imaging: A general linear approach,” Hum. Brain Mapp., 2, 189–210 (1995).Google Scholar
- 33.L. A. Mayorova, A. G. Petrushevsky, and O. N. Fedina, “A method for recording mismatch negativity networks using functional magnetic resonance imaging,” Biomed. Radioelektr., 2, 39–47 (2015).Google Scholar
- 35.R. Chapey, J. F. Duchan, R. J. Elman, et al., “Life-participation approach to aphasia: a statement of values for the future,” in: Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders, R. Chapey (ed.), Lippincott, Williams & Wilkins, Baltimore (2008), 5th ed.Google Scholar
- 37.J. Greener, P. Enderby, and R. Whurr, “Pharmacological treatment for aphasia following stroke,” Cochrane Database Syst. Rev., 4, CD000424 (2001).Google Scholar
- 38.F. Nouwens, D. W. Dippel, M. de Jong-Hagelstein, et al., “Rotterdam Aphasia Therapy Study (RATS)-3: The efficacy of intensive cognitive-linguistic therapy in the acute stage of aphasia; design of a randomised controlled trial,” Trials, 14, No. 24 (2013), https://doi.org/ https://doi.org/10.1186/1745-6215-14-24.PubMedPubMedCentralGoogle Scholar
- 40.M. A. Barbancho, M. L. Berthier, P. Navas-Sánchez, et al., “Bilateral brain reorganization with memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia: An ERP study,” Brain Lang., 145–146, 1–10 (2015), https://doi.org/ https://doi.org/10.1016/j.bandl.2015.04.003.Google Scholar
- 43.D. Saur, R. Lange, A. Baumgaertner, et al., “Dynamics of language reorganization after stroke,” Brain, 129, No. 6, 1371–1384 (2006).Google Scholar
- 44.C. F. Doeller et al., “Prefrontal cortex involvement in preattentive auditory deviance detection: Neuroimaging and electrophysiological evidence,” Neuroimage, 20, No. 2, 1270–1282 (2003).Google Scholar
- 46.T. Rinne, A. Degerman, and K. Alho, “Superior temporal and inferior frontal cortices are activated by infrequent sound duration decrements: An fMRI study,” Neuroimage, 26, No. 1, 66–72 (2005).Google Scholar