Neurolinguistic Intervention and Cortical Stimulation in Agrammatic Aphasia

描述（由申请人提供）：本项目的目标是研究如何通过植入电极进行皮层刺激来增强卒中后失语症患者的语言强化语言治疗。我们假设，在强化行为语言治疗期间给予皮层刺激，将加强和维持学习效果。许多布洛卡失语症患者表现为语法缺失，即难以理解和产生句子，特别是具有复杂句法的句子。对失语症行为治疗的研究正在逐步推出更完善的干预方法。然而，尽管失语症患者的语言改善在中风后许多年仍然可以表现出来，但似乎存在一个自然的神经生理学界限，即单独使用行为治疗可能达到的效果。因此，在目前的研究项目中，我们将评估增强和维持语言治疗有益效果的潜力，方法是刺激已知可能支持训练过的语言处理的核心脑区，同时进行行为干预。我们期望一个密集和集中的语言治疗方案，结合关键语言区域的皮层刺激，导致语法失用性失语症的语言功能的显着和持久的改善，超过没有皮层刺激治疗后看到的改善。这项新的研究汇集了神经外科和皮层刺激，神经生理学，神经语言学和失语症治疗领域的多学科研究人员，并有望提高失语症的语言恢复，提高失语症语言改善的现有上限。10名无语法性失语症患者将接受64次强化语言治疗，重点是句子构建过程和语法标记。在治疗阶段之前，其中五名参与者将植入皮层刺激装置，该装置将在语言行为治疗期间打开。功能成像研究用于确定最佳的植入定位，以及研究治疗和刺激对神经可塑性的影响。将使用一组广泛的语言测试来评估两个受试者组的治疗效果及其维持情况。公共卫生相关性：如果该项目成功，它将为真正的失语症治疗新方法奠定基础。这种方法的目标是语言障碍的物理原因，即通过直接皮层刺激结合语言治疗，对参与语言处理和产生的神经元网络的损伤。

DESCRIPTION (provided by applicant): The goal of this project is to investigate how linguistically grounded intensive language treatment for individuals with aphasia after stroke can be enhanced by cortical stimulation, performed with implanted electrodes. We hypothesize that cortical stimulation, administered during intensive behavioral language treatment, will strengthen and sustain learning effects. Many speakers with Broca's aphasia present with agrammatism, i.e. difficulty with comprehending and producing sentences, particularly sentences with complex syntax. Research into behavioral treatment for aphasia is progressively leading to more refined methods of intervention. However, although language improvement in speakers with aphasia can still be shown many years after their stroke, there does seem to be a natural, neurophysiological boundary as to what is possible to achieve with behavioral therapy alone. In the current research project, therefore, we will assess the potential to enhance and sustain the beneficial effects of language treatment, by stimulating core brain areas that are known to potentially support language processing of the kind that is trained, simultaneous to behavioral intervention. We expect a program of intensive and focal language treatment, in combination with cortical stimulation of crucial language areas, to lead to significant and long-lasting improvement of language functions in agrammatic aphasia, in excess of the improvement seen after treatment without cortical stimulation. This novel research brings together a multidisciplinary team of established researchers in the areas of neurosurgery and cortical stimulation, neurophysiology, neurolinguistics and treatment for aphasia and holds promise to enhance language recovery in aphasia, raising the existing cap on language improvement in aphasia. Ten participants with agrammatic aphasia will receive 64 sessions of intense language treatment, focused on sentence building processes and grammatical markers. Prior to the treatment phase, five of these participants will be implanted with a cortical stimulation device, which will be switched on during language behavioral treatment. Functional imaging studies are used to determine optimal implant localization, as well as to investigate effects of treatment and stimulation on neural plasticity. An extensive battery of language tests will be used to assess treatment effects and their maintenance in the two subject groups. PUBLIC HEALTH RELEVANCE: If the project is successful, it will lay the groundwork for a truly new approach to aphasia treatment. This approach targets the physical cause of the language impairment, namely, damage to neuronal networks involved in language processing and production, through direct cortical stimulation in combination with language therapy.