How Does iReadMore Therapy Change the Reading Network of Patients with Central Alexia?
How Does iReadMore Therapy Change the Reading Network of Patients with Central Alexia?
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DOI：
10.1523/jneurosci.1426-18.2019
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发表时间：
2019-05
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影响因子：
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通讯作者：
S. Kerry;O. M. Aguilar;W. Penny;J. Crinion;A. Leff;Z. Woodhead
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作者：
S. Kerry;O. M. Aguilar;W. Penny;J. Crinion;A. Leff;Z. Woodhead
中枢性失读症是一种获得性阅读障碍，同时伴有全身性语言缺陷(失语症)。卒中后失语恢复过程中，皮损周围和皮损组织的作用尚不清楚。我们调查了阅读训练(使用iReadMore，一款治疗应用程序)对CA患者阅读网络左右半球内部和之间联系的影响。在单纯失读症患者中，iReadMore增加了从左额下回(IFG)到左枕区(OCC)的反馈。我们的目标是确定iReadMore疗法是否通过类似的机制对CA患者有效。慢性卒中后CA患者(n=23)在4周内完成了35h的iReadMore训练。在治疗前和治疗后评估训练和未训练单词的阅读准确性。采用事件相关脑磁图技术，研究了大脑左右OCC区、枕颞区腹侧区和IFG区对阅读训练单词和未训练单词的神经反应。用动态因果模型在群体水平上模拟了训练对区域间有效连通性的调节作用。IReadMore训练使参与者的阅读准确率平均提高了8.4%(范围为−2.77%至31.66%)，而未经训练的单词的准确率保持稳定。训练增加了双侧额叶和枕区的区域敏感度，并加强了左半球内的前馈联系。我们的数据表明，这些患者的iReadMore训练调整了低阶视觉表征，而不是更高阶、更抽象的表征，以提高单词阅读的准确性。意义陈述这是第一项对中风后中枢性失读症患者的治疗效果进行网络水平分析的研究。当患者接受iReadMore(一种多模式、行为、大众实践、基于计算机的治疗)培训时，在培训项目上阅读准确率平均提高了8.4%。对与这一改善相关的脑磁图数据的网络分析显示，双侧额叶和枕区的区域敏感度增加，左半球内的前馈连接加强。这表明，在CA患者中，iReadMore利用左半球(病变位置后面)较低顺序的完整资源来提高单词阅读能力。这为今后研究不同CA亚型的阅读网络调节或句子水平的治疗提供了基础。
Central alexia (CA) is an acquired reading disorder co-occurring with a generalized language deficit (aphasia). The roles of perilesional and ipsilesional tissue in recovery from poststroke aphasia are unclear. We investigated the impact of reading training (using iReadMore, a therapy app) on the connections within and between the right and left hemisphere of the reading network of patients with CA. In patients with pure alexia, iReadMore increased feedback from left inferior frontal gyrus (IFG) region to the left occipital (OCC) region. We aimed to identify whether iReadMore therapy was effective through a similar mechanism in patients with CA. Participants with chronic poststroke CA (n = 23) completed 35 h of iReadMore training over 4 weeks. Reading accuracy for trained and untrained words was assessed before and after therapy. The neural response to reading trained and untrained words in the left and right OCC, ventral occipitotemporal, and IFG regions was examined using event-related magnetoencephalography. The training-related modulation in effective connectivity between regions was modeled at the group level with dynamic causal modeling. iReadMore training improved participants' reading accuracy by an average of 8.4% (range, −2.77 to 31.66) while accuracy for untrained words was stable. Training increased regional sensitivity in bilateral frontal and occipital regions, and strengthened feedforward connections within the left hemisphere. Our data suggest that iReadMore training in these patients modulates lower-order visual representations, as opposed to higher-order, more abstract representations, to improve word-reading accuracy. SIGNIFICANCE STATEMENT This is the first study to conduct a network-level analysis of therapy effects in participants with poststroke central alexia. When patients trained with iReadMore (a multimodal, behavioral, mass practice, computer-based therapy), reading accuracy improved by an average 8.4% on trained items. A network analysis of the magnetoencephalography data associated with this improvement revealed an increase in regional sensitivity in bilateral frontal and occipital regions and strengthening of feedforward connections within the left hemisphere. This indicates that in patients with CA iReadMore engages lower-order, intact resources within the left hemisphere (posterior to their lesion locations) to improve word reading. This provides a foundation for future research to investigate reading network modulation in different CA subtypes, or for sentence-level therapy.