Treatment of attention and intention in aphasia

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Growing evidence indicates that deficits in attention (defined as selection of one external source of information for further processing) and intention (defined as preparation to respond, including choosing one course of action as opposed to others) accompany aphasia. These deficits may exacerbate language symptoms such as naming difficulty in some instances, and language functions may improve when attention/intention manipulations are applied. Specifically, when some premorbidly right-handed patients with aphasia after left-hemisphere lesion are required to attend to stimuli in their left hemispace or gesture with their left hands, they are better able to formulate and/or understand language. In such cases, it seems likely that attending to stimuli in hemispace contralateral to the intact hemisphere or initiating an action with the hand contralateral to the intact hemisphere, engages intact attention or intention mechanisms, respectively, in that hemisphere which then compensate for dysfunctional mechanisms in the damaged hemisphere. The purpose of this subproject is to develop and apply aphasia treatments designed to recruit attention or intention mechanisms in the intact hemisphere and to engage them in language processing. Treatments will target naming; patients who have chronic difficulty in naming will be studied. In addition to assessing the effectiveness of treatments for individual patients, fMRI will be used to explore whether the effects are accomplished by shifting attention and intention demands to the mechanisms in the non-dominant hemisphere. Broader "functional" aspects of language will also be assessed.