fMRI of Language Recover Following Stroke in Adults

描述（由申请人提供）：中风后失语与高死亡率和严重的运动、社交和认知障碍有关。在过去的十年里，中风治疗小组在限制中风造成的损害方面取得了很大的进展。失语康复的进展没有经历同样的快速进展。这一建议是基于我们和其他人提供的儿童和成人的证据，这些证据表明大脑可能具有未开发的中风后失语恢复潜力。挖掘这一潜力的第一步和本研究的总体目标是了解支持语言功能的神经回路如何对急性缺血性损伤做出反应，以恢复语言功能。下一步，我们将测试一种新的治疗策略对失语症恢复和语言神经回路可塑性的影响。通过实施干预，我们将提供临床和神经影像学证据，证明约束性失语治疗（CIAT）对中风后的语言恢复有积极的影响。这些发现将对理解不同年龄组之间语言可塑性的差异以及设计有效的治疗干预措施产生影响。为了填补这一空白，我们提出了一项具有以下具体目标的研究：(1)在年轻人和老年人中，我们将绘制LMCA中风后语言激活模式的纵向变化，并使用fMRI确定语言定位和侧化。我们将比较成人组的语言激活模式与我们之前研究中发现的围产期和产后中风儿童的语言激活模式；(2)在右脑和非右脑LMCA中风患者中，我们将使用功能磁共振成像绘制语言激活的变化，评估两组之间卒中后语言恢复的差异，并确定非右脑患者是否表现出a)与右脑患者相比，语言分布更对称或右脑偏侧，b)偏侧的变化是否与失语恢复相关。c)这些患者是否激活了额外的语言处理和产生区域；(3)我们将通过一项试点研究证明，与传统护理相比，在中风事件发生一年后给予CIAT对中风后慢性失语症的恢复有积极影响。我们将运用CIAT、功能磁共振成像（fMRI）和神经心理学测量来记录右脑和非右脑LMCA中风患者脑卒中后语言恢复的临床和解剖学相关性。中风后语言功能丧失（失语症）是中风最可怕的症状之一。语言是人类基本的认知功能。没有它，我们在社会中的社会和经济地位就会受到极大的损害。由于中风而失去语言能力的高生产力社会成员往往受到打击，可能无法以中风前的水平重新进入社会和职业生活。在这项研究中，我们将研究大脑在从失语引起的中风中恢复时所经历的变化，这种恢复的机制，并测试一种新的有前途的失语康复方法的疗效，这种方法被称为限制性失语疗法。

DESCRIPTION (provided by applicant): Aphasia after stroke is associated with high mortality and severe motor, social, and cognitive disability. During the past decade, therapies administered by stroke teams have made great strides to limit the damage due to a stroke. Progress in aphasia rehabilitation has not experienced the same rapid advancement. This proposal is based on evidence from children and adults provided by us and others suggesting that the brain may have untapped potential for recovery of aphasia after stroke. The first step toward accessing that potential and the overall aim of this proposal is to understand how the neural circuitry supporting language functions responds to acute ischemic injury in order to restore language functions. Further, we will take the next step of testing the impact of a new therapeutic strategy on aphasia recovery and on the plasticity of the underlying neural circuitry of language. By administering an intervention, we will provide clinical and neuroimaging evidence that constraint-induced aphasia therapy (CIAT) positively affects language recovery after stroke. The findings will have implications for understanding of the differences in language plasticity between different age groups and for the design of effective treatment interventions. To fill the gap in our knowledge we propose a study with the following specific aims: (1) In young and old adults we will map longitudinal changes in language activation patterns and determine language localization and lateralization using fMRI after LMCA stroke. We will compare the language activation patterns between the groups of adults with those found in children with perinatal and postnatal stroke from our previous studies; (2) In dextral and non-dextral LMCA stroke patients, we will map changes in language activation using fMRI, assess the differences in post-stroke language recovery between these groups, and determine whether non- dextral patients exhibit a) more symmetric or right-lateralized language distribution as compared to dextral patients, b) whether the changes in lateralization correlate with recovery from aphasia, and c) whether these patients activate additional language processing and production areas; and (3) We will demonstrate via a pilot study that CIAT administered 1 year after the incident stroke positively influences recovery of chronic aphasia after stroke when compared to traditional care. We will apply CIAT and use fMRI and neuropsychological measures to document the relationship between the clinical and anatomical correlates of post-stroke language recovery in dextral and non-dextral LMCA stroke patients. PUBLIC HEALTH RELEVANCE: Project narrative Loss of language functions after stroke (aphasia) is one of the most feared symptoms of stroke. Language is a fundamentally human cognitive function. Without it, our social and economic status in society is tremendously impaired. Highly productive members of the society who lose language capability due to a stroke are often devastated and may not be able to re-enter social and professional life at the pre-stroke level. In this study we will examine the changes the brain undergoes while recovering from an aphasia-causing stroke, the mechanisms that underlie such recovery, and test the efficacy of a new and promising method of aphasia rehabilitation called constraint-induced aphasia therapy.