Neuroscience and Behavioral Physiology

, Volume 49, Issue 9, pp 1184–1194 | Cite as

Regression of Poststroke Aphasia and Concomitant Nonspeech Syndromes Due to Courses of Restorative Therapy Including Intensive Speech Therapy

  • V. M. Shklovskij
  • V. V. Alferova
  • E. G. Ivanova
  • L. A. MayorovaEmail author
  • A. G. Petrushevsky
  • G. V. Ivanov
  • S. V. Kuptsova
  • E. A. Kondrateva
  • A. B. Guekht

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.


ischemic stroke poststroke aphasia severity of aphasia clinical form of aphasia nonspeech cognitive impairments intensive speech therapy poststroke plasticity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    E. S. Bein and P. A. Ovcharova, Clinical Features and Treatment of Aphasia, Medicine and Physiculture, Sofia (1970).Google Scholar
  2. 2.
    A. R. Luriya, Higher Cortical Functions of Humans, Piter, St. Petersburg (2008).Google Scholar
  3. 3.
    L. S. Tsvetkova, Aphasiology. Current Challenges and Approaches to Their Solution, MPSI MODEK, Moscow (2011).Google Scholar
  4. 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),
  5. 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),
  6. 6.
    A. Van der Gaag and R. Brooks, “Economic aspects of a therapy and support service for people with long-term stroke and aphasia,” Int. J. Lang. Commun. Disord., 43, No. 3, 233–444 (2008), Scholar
  7. 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. 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. 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), Scholar
  10. 10.
    K. D. Cicerone, D. M. Langenbahn, C. Braden, et al., “Evidencebased cognitive rehabilitation: updated review of the literature from 2003 through 2008,” Am. Soc. Phys. Med. Rehab., 92, No. 4, 519–530 (2011), Scholar
  11. 11.
    K. D. Cicerone, C. Dahlberg, K. Kalmar, et al., “Evidence-based cognitive rehabilitation: recommendations for clinical practice,” Arch. Phys. Med. Rehabil., 81, No. 12, 1596–1615 (2000), Scholar
  12. 12.
    A. Zumbansen and A. Thiel, “Recent advances in the treatment of post-stroke aphasia,” Neural Regen. Res., 9, No. 7, 703–706 (2014), Scholar
  13. 13.
    J. Greener, P. Enderby, and R. Whurr, “Pharmacological treatment for aphasia following stroke,” Cochrane Database Syst. Rev., 4, CD000424 (2001),
  14. 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), Scholar
  15. 15.
    S. K. Bhogal, R. Teasell, and M. Speechley, “Intensity of aphasia therapy, impact on recovery,” Stroke, 34, No. 4, 987–993 (2003), Scholar
  16. 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),
  17. 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), Scholar
  18. 18.
    C. Persad, L. Wozniak, and E. Kostopoulos, “Retrospective analysis of outcomes from two intensive comprehensive aphasia programs,” Top. Stroke Rehabil., 20, No. 5, 388–997 (2013), Scholar
  19. 19.
    L. S. Tsvetkova, Recovery of Higher Mental Functions, Academic Project, Moscow (2004).Google Scholar
  20. 20.
    L. S. Tsvetkova, Aphasia and Restorative Training: Textbook, Moscow Psychosocial Institute, Moscow; MODEK, Voronezh (2005).Google Scholar
  21. 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. 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. 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. 24.
    A. R. Luriya, Basic Neuropsychology, Moscow University Press, Moscow (1973).Google Scholar
  25. 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
  26. 26.
    W. G. Barsan, C. P. Olinger, H. P. Adams Jr., et al., “Use of high dose naloxone in acute stroke: possible side-effects,” Crit. Care Med., 17, No. 8, 762–767 (1989).PubMedGoogle Scholar
  27. 27.
    F. Mahoney and D. Barthel, “Functional evaluation: the Barthel Index,” Md. Med. J., 14, 61–65 (1965).Google Scholar
  28. 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), Scholar
  29. 29.
    F. Fazekas, J. B. Chawluk, A. Alavi, et al., “MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging,” Am. J. Roentgenol., 149, No. 2, 351–356 (1987), Scholar
  30. 30.
    K. W. Kim, J. R. MacFall, and M. E. Payne, “Classification of white matter lesions on magnetic resonance imaging in elderly persons,” Biol. Psychiatry, 64, No. 4, 273–280 (2008), Scholar
  31. 31.
    C. Rorden and M. Brett, “Stereotaxic display of brain lesions,” Behav. Neurol., 12, No. 4, 191–200 (2000).PubMedGoogle Scholar
  32. 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. 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
  34. 34.
    E. Galletta and A. M. Barrett, “Impairment and functional interventions for aphasia: having it all,” Curr. Phys. Med. Rehabil. Rep., 2, No. 2, 114–120 (2014), Scholar
  35. 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
  36. 36.
    L. R. Cherney, J. P. Patterson, A. Raymer, et al., “Evidence-based systematic review: effects of intensity of treatment and Constraint-Induced Language Therapy for individuals with stroke-induced aphasia,” J. Speech Lang. Hear. Res., 51, 1282–1299 (2008).PubMedGoogle Scholar
  37. 37.
    J. Greener, P. Enderby, and R. Whurr, “Pharmacological treatment for aphasia following stroke,” Cochrane Database Syst. Rev., 4, CD000424 (2001).Google Scholar
  38. 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), Scholar
  39. 39.
    B. Stahl, B. Mohr, V. Buscher, et al., “Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial,” J Neurol. Neurosurg. Psychiatry (2017), pii: jnnp-2017-315962, Scholar
  40. 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), Scholar
  41. 41.
    B. Sul, J. S. Kim, B. Y. Hong, et al., “The Prognosis and recovery of aphasia related to stroke lesion,” Ann. Rehab. Med., 40, No. 5, 786–793 (2016), Scholar
  42. 42.
    H. El Hachioui et al., “Recovery of aphasia after stroke: a 1-year follow-up study,” J. Neurol., 260, No. 1, 166–171 (2013).PubMedGoogle Scholar
  43. 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. 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
  45. 45.
    B. Opitz et al., “Differential contribution of frontal and temporal cortices to auditory change detection: fMRI and ERP results,” Neuroimage, 15, No. 1, 167–174 (2002).PubMedGoogle Scholar
  46. 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

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • V. M. Shklovskij
    • 1
    • 4
  • V. V. Alferova
    • 1
    • 2
  • E. G. Ivanova
    • 1
    • 2
  • L. A. Mayorova
    • 1
    • 3
    Email author
  • A. G. Petrushevsky
    • 1
  • G. V. Ivanov
    • 5
  • S. V. Kuptsova
    • 1
    • 3
  • E. A. Kondrateva
    • 6
  • A. B. Guekht
    • 2
    • 7
  1. 1.Center for Speech Pathology and NeurorehabilitationMoscow Health DepartmentMoscowRussia
  2. 2.Pirogov Russian National Research Medical UniversityRussian Ministry of HealthMoscowRussia
  3. 3.Institute of Higher Nervous Activity and NeurophysiologyRussian Academy of SciencesMoscowRussia
  4. 4.Serbskii Federal Medical Research Center for Psychiatry and NarcologyRussian Ministry of HealthMoscowRussia
  5. 5.YandexMoscowRussia
  6. 6.Skolkovo Institute of Science and Technology (Skoltech)Moscow DistrictRussia
  7. 7.Solov’ev Scientific-Applied Psychoneurology CenterMoscow Health DepartmentMoscowRussia

Personalised recommendations