Recovery of language and theory of mind after stroke

中风后语言和心理理论的恢复

• 批准号: 10735907
• 负责人: MARGARET LEHMAN BLAKE
• 金额: $ 5.36万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735907
• 关键词: Acute; Address; Affect; Aphasia; Area; Attention; Behavior assessment; Behavioral; Behavioral Mechanisms; Brain; Brain Injuries; Brain region; Chronic; Cognitive deficits; Communication; Communication impairment; Comprehension; Country; Cues; Data; Dependence; Diagnosis; Emotional; Evolution; Facial Expression; Frequencies; Goals; Humor; Improve Access; Individual; Individual Differences; Inferior; Intervention; Knowledge; Laboratories; Language; Language Disorders; Lead; Left; Lesion; Life; Longitudinal Studies; Maps; Measures; Metaphor; Methods; Mind; Modeling; Neuroanatomy; Neuropsychological Tests; Outcome; Parietal; Patients; Pattern; Probability; Production; Public Health; Quality of life; Recovery; Rehabilitation therapy; Right cerebral hemisphere; Sample Size; Short-Term Memory; Social Interaction; Speech; Stroke; Structure; Symptoms; Testing; Time; acute stroke; behavior measurement; brain behavior; chronic stroke; cognitive ability; cohort; executive function; health care availability; improved; inclusion criteria; innovation; language comprehension; longitudinal analysis; neural; neuroimaging; neuromechanism; non-verbal; patient population; post stroke; predictive modeling; recruit; social; social communication; social deficits; theories; tool; white matter

Project Summary Left and right hemisphere (RH) strokes occur at similar frequencies and both are associated with life-altering communication deficits. However, patients with RH stroke rarely receive speech-language intervention, likely because they do not present with obvious language deficits like aphasia. Instead, they have difficulties engaging in typical conversations which require understanding what a speaker means, especially when in opposition to what was actually said, such as occurs in sarcasm, humor and metaphors. A specific deficit in the ability to understand others’ perspectives and intended meanings, known as theory of mind (ToM) may be a primary cause of communication deficits and a critical component of differential recovery after RH stroke. Inappropriately responding during conversation due to misunderstandings of what a speaker knows and intends creates poor social interactions and negatively impacts relationships. For those living with RH stroke, communication deficits have profoundly damaging effects on quality of life. Our central hypothesis is that RH stroke causes discourse-level language deficits due to damage to brain areas critical to ToM, an essential component of social communication. Our goal is to assess language and ToM abilities from acute to chronic stages of RH stroke while collecting neuroanatomical and quality of life data. We will measure the contribution of other social deficits including the processing of emotional prosody and non-verbal cues (e.g., facial expressions) as well as cognitive deficits including working memory, executive function, and attention. To date, estimates of language and ToM deficits which occur after RH stroke and the relationship between them are inconsistent or unexplored. Most studies examine patients in rehabilitation settings who likely have large strokes and more severe communication disorders, creating a bias in our knowledge about the effects of stroke. The effects of damage to RH brain regions, their connections, and how they contribute to language recovery are also unknown, limiting decisions about treatment priorities. Lastly, whether language recovery depends on ToM is unknown as there are no longitudinal studies of communication recovery from acute RH stroke. We will address these gaps by examining individuals in a large group of acute stroke subjects, as they progress from acute to chronic stroke to evaluate the relationship between changes in language, ToM and their dependence on neural recovery. Our innovative approach combines recent advances in neuropsychological testing and neuroimaging analysis to provide converging causal evidence to validate a ToM theory of RH stroke communication. Aim 1 tests the hypothesis that language depends on intact ToM at the acute stage of stroke before functional reorganization. Aim 2 tests the hypothesis that language depends on ToM associated neural structures and connectivity acutely, before functional reorganization. Aim 3 examines recovery of language and relationships with ToM and brain structure by assessing behavioral and neural changes across the first year after stroke. Successful outcomes include understanding the behavioral and neural mechanisms underlying RH deficits, their evolution post-stroke, and their impact on quality of life. As a result, we will be able to develop better assessment and intervention tools, improving access to health care and long-term outcomes for this underserved patient population.

项目摘要 左半球和右半球（RH）中风发生的频率相似，两者都与生活改变有关。 沟通缺陷。然而，RH卒中患者很少接受言语-语言干预，可能是因为 他们并不表现出明显的语言缺陷，如失语症。相反，他们很难参与典型的 需要理解说话者的意思的谈话，特别是当与实际相反时。 说，如发生在讽刺，幽默和隐喻。在理解他人观点的能力方面存在特定缺陷 和预期意义，被称为心理理论（ToM）可能是沟通缺陷的主要原因， RH中风后差异恢复的关键组成部分。在谈话中不适当地回应， 对演讲者所知和意图的误解会造成不良的社会互动和负面影响 关系。对于那些患有RH中风的人来说，沟通缺陷对他们的生活质量有着深刻的破坏性影响。 生活我们的中心假设是RH中风由于大脑区域的损伤而导致话语水平的语言缺陷 对心理理论至关重要，心理理论是社会沟通的重要组成部分。我们的目标是评估语言和心理理论能力， RH中风的急性到慢性阶段，同时收集神经解剖学和生活质量数据。我们将测量 其他社会缺陷的贡献包括情绪韵律和非语言线索的处理（例如，面部 表达）以及认知缺陷，包括工作记忆、执行功能和注意力。到目前为止， 对RH卒中后出现的语言和心理理论缺陷以及它们之间的关系的估计不一致 或未开发的。大多数研究都是在康复环境中检查可能患有大中风和更严重中风的患者， 交流障碍，造成我们对中风影响的认识存在偏见。对RH的损害 大脑区域，它们的连接，以及它们如何有助于语言恢复也是未知的，限制了决策 治疗的优先顺序最后，语言恢复是否依赖于心理理论尚不清楚，因为没有纵向的 急性RH卒中的沟通恢复研究。我们将通过在大范围内检查个人来解决这些差距 一组急性卒中受试者，当他们从急性进展到慢性卒中时， 语言、心理理论及其对神经恢复的依赖性的变化。我们的创新方法结合了最近 神经心理学测试和神经影像学分析的进展，以提供会聚的因果证据来验证 心理理论的RH中风沟通。目的1检验了语言依赖于完整的心理理论的假设， 功能重组前的中风阶段。目标2检验了语言依赖于相关心理理论的假设 在功能重组之前，神经结构和连接急剧变化。目标3研究语言的恢复， 通过评估中风后第一年的行为和神经变化，研究ToM与大脑结构的关系。 成功的结果包括理解RH缺陷的行为和神经机制， 中风后的演变及其对生活质量的影响。因此，我们将能够制定更好的评估， 干预工具，改善获得医疗保健和长期结果，为这一服务不足的患者群体。