Neural Correlates of Aphasia Treatment and Recovery: fMRI Investigations

描述（由申请人提供）：本提案中描述的工作目标是为失语症治疗和恢复机制提供基于神经影像学的检查。我们建议在四个实验中使用功能磁共振成像以及结构和灌注磁共振成像作为跟踪、记录和评估与治疗相关的大脑行为变化的工具。我们建议系统地检查治疗的行为和（相关的）神经效应，同时操纵几个关键的基于患者和基于治疗的变量，这些变量被假设与失语症的恢复有关。我们将研究的与患者相关的变量包括病变的部位和范围、前病变与后病变患者、中风后早期与中风后晚期（慢性）恢复阶段。我们建议研究治疗（与安慰剂治疗）对这些患者的影响，重点关注句子水平加工的理解和产生缺陷，比较两种不同的治疗强度计划（强化与扩展）和两种不同的治疗复杂性条件（训练复杂到简单的结构与简单到复杂的结构）。我们对后一个变量的关注是基于我们之前的工作表明，与后者相比，前者（从复杂到简单的训练）产生了更大的治疗效果和泛化效应。此外，我们建议进行行为研究，将这种“治疗复杂性”假说的检验扩展到语言处理的新领域和新的人群（患有韦尼克失语症的后侧病变患者）。总的来说，我们建议采用（并重复）具有先前证明的行为功效的治疗方法，以便为检查（通过神经成像）与治疗期间一系列关键的基于患者和基于治疗的变量相关的基于大脑的变化提供坚实的基础。此外，我们建议将复杂性方法的理论动机扩展到语言处理的新领域。

DESCRIPTION (provided by applicant): The goal of the work described in this proposal is to provide a neuroimaging-based examination of the mechanisms of aphasia treatment and recovery. We propose to use functional magnetic resonance imaging together with structural and perfusion MR imaging as tools for tracking, recording and evaluating brain behavior changes linked to treatment-based changes in four experiments. We propose to systematically examine both behavioral and (correlated) neural effects of treatment while manipulating several critical patient-based and treatment-based variables that have been hypothesized to be relevant to aphasia recovery. The patient-related variables we will study include site and extent of lesion, in patients with anterior vs. posterior lesions, in early post-stroke vs. late post-stroke (chronic) stages of recovery. We propose to study the effects of treatment (vs. placebo-treatment) for these patients with a focus on both comprehension and production deficits in sentence level processing, comparing: two different treatment-intensity schedules (intensive vs. extended) and two different complexity-of-treatment conditions (training complex-to-simple vs. simple-to-complex structures). Our focus on this latter variable is based on our previous work showing that the former (complex-to-simple training) results in greater efficacy of treatment and generalization effects as compared to the latter. Additionally, we propose behavioral studies that extend examination of this 'complexity-of treatment' hypothesis into new domains of language processing and new populations (posteriorly lesioned patients with Wernicke's aphasia). Overall, we propose to employ (and replicate) treatment methods with previously demonstrated behavioral efficacy so as to provide a solid basis for examining (via neuroimaging) brain-based changes associated with a range of critical patient-based and treatment-based variables during treatment. Additionally, we propose to examine theoretically motivated extensions of the complexity method to new domains of language treatment.