Concurrent Validity, Test-Retest Reliability, and Sensitivity to Change of Functional Near-Infrared Spectroscopy for Measuring Language-Related Brain Activity in Post-Stroke Aphasia

在美国，超过250万人患有失语症，这是一种语言障碍，最常见的原因是中风 极大地影响个人的功能独立性和生活质量。几十年来，功能磁共振成像一直 非常先进的失语症研究，但它有显著的局限性。例如，有条件的个人 影响许多退伍军人的疾病(例如，植入的医疗器械或涉及金属的伤病史)不能安全 接受扫描。因此，这些人被系统地排除在失语症的功能磁共振研究之外。 此外，功能磁共振成像是在嘈杂、受限的环境中进行的，这就需要使用人工 实验范式可能不涉及全面的解剖学和生理学机制 支持真实语言和交流功能。与功能磁共振成像相比，功能性近红外 光谱学(FNIRS)几乎没有禁忌症，无声，价格低廉，可以在标准条件下使用。 诊所里有自然主义的语言范例。尽管有这些优点，fNIRS很少被用来 研究失语症，可能是因为在这一特定人群中，与fMRI相比，缺乏数据来证实它。这 研究将通过调查其相关性来解决支持fNIR使用的证据中的关键差距 使用fMRI进行语言映射(Aim 1)，其重测信度(Aim 2)及其对变化的敏感性 慢性卒中后失语症患者行为语言治疗的脑功能(目标3)。 在这项研究的A部分，24名慢性失语症(PWA)患者将在3周内接受两次扫描 同时使用fNIR和fMRI，同时执行三种语言任务：图片命名和语义和 音位匹配。同时效度将通过关联语言激活来建立，由 FNIRS与fMRI比较。FNIRS的重测信度将通过计算组内相关性进行评估 第一次和第二次fNIRS扫描的系数，以及与fMRI扫描的可比比较。二十- 四名健康的老年人将完成相同的方案，以告知PWA的结果解释。在……里面 B部分，12名PWA将在三周前和三周后在语言任务中完成fNIR和fMRI扫描 强化语言治疗，作为单词提取治疗的单独临床试验的一部分 减损。治疗前后的fNIRS和fMRI扫描的比较将被用来评估 FNIRS对干预后变化的敏感度，相对于fMRI。行为研究活动(包括 强化语言治疗)将在退伍军人事务部匹兹堡医疗系统(VAPHS)进行。功能磁共振成像和 FNIRS将在CMU-PIT脑成像数据生成和教育中心和大脑进行 和匹兹堡大学的听觉科学研究计划。 这项研究的结果将有助于确定fNIRS用于测量语言功能的可行性 卒中后失语症并可能为fNIRS在失语症研究中的更多使用提供基础，扩大 参与神经影像研究，并增加其研究结果的概括性。结果也可能是 支持fNIR的新用途的开发，例如测量日常语言中的大脑反应 使用或失语治疗，并使用实时神经反馈作为行为失语治疗的辅助。 申请人是退伍军人事务部CDA-1奖获得者、研究和临床言语病理学家、前高级 VAPHS老年学研究、教育和临床中心的老年病学研究员，具有 失语症康复和功能磁共振检查。在CDA-2期间，指导和有组织的高级培训活动 神经成像/fNIRS方法、高级统计学、贝叶斯适应性临床试验设计和有效性理论 将促进项目的执行和完成，并实现申请人的职业目标。这些 目标包括完成CDA-2并成为由VA Merit支持的独立VA临床医生兼科学家 审查和NIH/NIDCD奖励机制，研究方案侧重于改善服务提供 以及最大限度地提高退伍军人和其他失语症患者的治疗效果。

More than 2.5 million people in the U.S. have aphasia, a language disorder most often caused by stroke that dramatically affects an individual’s functional independence and quality of life. For several decades, fMRI has critically advanced aphasia research, but it has notable limitations. For example, individuals with conditions that affect many Veterans (e.g., implanted medical devices or a history of injury involving metal) cannot safely be scanned. These individuals have therefore been systematically excluded from fMRI studies of aphasia. Additionally, fMRI is conducted in a noisy, restrictive environment, necessitating the use of artificial experimental paradigms that may not engage the full range of anatomical and physiological mechanisms supporting real-world language and communicative function. In contrast to fMRI, functional near-infrared spectroscopy (fNIRS) has few contraindications, is silent, inexpensive, and can be administered in a standard clinic room with naturalistic language paradigms. Despite these advantages, fNIRS has rarely been used to study aphasia, likely due to a lack of data validating it as compared to fMRI in this specific population. This study will address critical gaps in the evidence that would support fNIRS’ use by investigating its correlation with fMRI for language mapping (Aim 1), its test-retest reliability (Aim 2), and its sensitivity to changes in brain function due to behavioral language treatment (Aim 3) in people with chronic post-stroke aphasia. In part A of this study, 24 people with chronic aphasia (PWA) will be scanned twice over a 3-week interval with both fNIRS and fMRI while performing three language tasks: picture naming and semantic and phonological matching. Concurrent validity will be established by correlating language activation measured by fNIRS with that of fMRI. fNIRS’ test-retest reliability will be assessed by computing intraclass correlation coefficients across the first and second fNIRS scans, with comparable comparisons of the fMRI scans. Twenty- four healthy older adults will complete the same protocols to inform interpretations of the results in PWA. In part B, 12 PWA will complete fNIRS and fMRI scans during language tasks before and after three weeks of intensive language therapy, administered as part of a separate clinical trial of treatment for word-retrieval impairments. Comparisons between pre- and post-treatment fNIRS and fMRI scans will be used to assess fNIRS’ sensitivity to change after intervention, relative to that of fMRI. Behavioral research activities (including intensive language therapy) will be conducted at the VA Pittsburgh Healthcare System (VAPHS). fMRI and fNIRS will be performed at the CMU-Pitt Brain Imaging Data Generation & Education Center and the Brain and Auditory Sciences Research Initiative at the University of Pittsburgh, respectively. The results of this study will help determine the viability of fNIRS for measuring language functions in post-stroke aphasia and may provide a foundation for increased use of fNIRS in aphasia research, broadening participation in neuroimaging studies and increasing the generalizability of their findings. The results may also support the development of novel uses for fNIRS, such as measuring brain responses during everyday language use or aphasia treatment, and using real-time neurofeedback as an adjuvant to behavioral aphasia therapy. The applicant is a VA CDA-1 awardee, research and clinical speech pathologist, and former Advanced Geriatrics Fellow in the Geriatric Research, Education, and Clinical Center at VAPHS, with experience in aphasia rehabilitation and fMRI. During the CDA-2, mentorship and structured training activities in advanced neuroimaging/fNIRS methods, advanced statistics, Bayesian adaptive clinical trials design, and validity theory will facilitate execution and completion of the project and achievement of the applicant’s career goals. These goals include completing a CDA-2 and becoming an independent VA clinician-scientist supported by VA Merit Review and NIH/NIDCD award mechanisms, with a research program focused on improving service delivery and maximizing treatment outcomes for Veterans and others with aphasia.