Neurophysiological Measurement in Aphasia Treatment

失语症治疗中的神经生理学测量

基本信息

批准号：
6910405
负责人：
Steven L Small
金额：
$ 41.87万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-04-01 至 2010-03-31
项目状态：
已结题

项目摘要

Both functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) can be helpful in characterizing the neurophysiological status of patients with aphasia. Such measurements can be used to develop treatment approaches, select patient-specific treatments, and gauge the effectiveness of treatment. However, brain imaging in aphasia must be improved. Both fMRI and DTI are highly sensitive to both head motion and oropharyngeal motion, and these artifacts are exacerbated in patients with non-fluent aphasia, who have a more difficult time producing speech. Stroke is often precipitated by and/or accompanied by alterations in vasculature, which can affect the MRI signal. Hemodynamic redistribution leads to ambiguity about the source of MRI signals presumed to indicate neural reorganization and/or remodeling. Artifacts from reperfusion hemorrhage leads to susceptibility artifact in the vicinity of lesions. The proposed work will specifically address each of these technical issues to facilitate the use of neurophysiological (functional imaging) measures in patients with aphasia. For fMRI and DTI to guide therapeutic decision-making, there must be formal ways to characterize the physiological state of individual patients and to correlate biological and behavioral parameters. In this proposal, we develop two classes of measures, scalar indices and network activation maps, and investigate their relationship to measures of speech and language. Scalar indices reduce an entire pattern of activation into a single number, such as degree of brain lateralization or integrity of callosal white matter. Network maps include structural equation models and Euclidean distance maps, and we develop methods to compare such large-scale models between individuals or groups (e.g., patients who do and do not benefit from therapy). This component of the research aims to develop rational neurophysiological measures for aphasia research. Finally, these methodological improvements will be applied to a treatment study for patients with chronic non-fluent aphasia and left frontal lesions. The therapeutic intervention is based on (a) neurobiological observations that the brain has circuits particularly active in motor imitation through observation-execution matching, including oral motor imitation; (b) behavioral observations that imitation is a cornerstone of many treatments for non-fluent aphasia; and (c) treatment data that favor intensive approaches and graded incremental learning. Outcomes are assessed by both physiological and behavioral measures, which are collected every three weeks starting six weeks before treatment and ending six weeks after completion of treatment.

功能性磁共振成像（fMRI）和扩散张量成像（DTI）都可以帮助表征失语症患者的神经生理状况。这种测量可用于开发治疗方法，选择特定于患者的治疗并评估治疗的有效性。但是，必须改善失语症中的大脑成像。 fMRI和DTI都对头部运动和口咽运动都高度敏感，并且这些非浮力失语症患者的这些伪像会加剧，这些患者的语音更加困难。中风通常由和/或伴随着脉管系统的改变，这可能会影响MRI信号。血液动力学重新分布导致对指示神经重组和/或重塑的MRI信号来源的歧义。再灌注出血的伪影导致病变附近的敏感性伪像。拟议的工作将专门解决这些技术问题，以促进失语症患者的神经生理（功能成像）测量。为了指导治疗决策，fMRI和DTI必须有形式的方法来表征个别患者的生理状态并与生物学和行为参数相关。在此提案中，我们开发了两类措施，标量指数和网络激活图，并研究它们与语音和语言度量的关系。标量指数将整个激活模式降低为单个数字，例如大脑横向化程度或Callosal White Matter的完整性。网络地图包括结构方程模型和欧几里得距离图，我们开发了比较个体或组之间的大规模模型（例如，做和不从治疗中受益的患者）进行比较。该研究的这一组成部分旨在制定合理的神经生理学措施以进行失语研究。最后，这些方法学改进将用于针对慢性非浮力失语和左额叶病变的患者的治疗研究。治疗性干预基于（a）神经生物学观察，即大脑通过观察性执行匹配（包括口服运动模仿）在运动模仿中特别活跃的电路；（b）模仿的行为观察是许多非浮力失语症的许多治疗方法的基石；（c）有利于强化方法和分级增量学习的治疗数据。结局通过生理和行为措施评估，这些措施每三周从治疗前六周开始收集一次，并在完成后六周结束治疗。