fMRI of Language Recover Following Stroke in Adults

描述(由申请人提供)：中风后的失语症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，中风团队实施的治疗方法在限制中风造成的损害方面取得了长足的进步。失语症康复方面的进展并没有经历同样迅速的进展。这一建议是基于我们和其他人提供的来自儿童和成人的证据，表明大脑可能具有中风后失语症恢复的未开发潜力。获得这种潜力的第一步，也是这项提议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。此外，我们将进一步测试新的治疗策略对失语症康复和语言潜在神经回路的可塑性的影响。通过实施干预，我们将提供临床和神经影像证据，证明强制性失语治疗(CIAT)对中风后语言恢复有积极影响。这一发现将对理解不同年龄段之间语言可塑性的差异以及设计有效的治疗干预措施具有重要意义。为了填补我们知识上的空白，我们提出了一项有以下具体目的的研究：(1)在年轻人和老年人中，我们将绘制LMCA卒中后语言激活模式的纵向变化图，并使用fMRI来确定语言的定位和偏侧化。我们将比较成人组和我们先前研究中发现的围产期和出生后中风儿童的语言激活模式；(2)在右旋和非右旋LMCA卒中患者中，我们将使用功能磁共振成像绘制语言激活的变化图，评估这些组之间在卒中后语言恢复方面的差异，并确定非右旋患者是否表现出a)比右旋患者更对称或右侧化的语言分布，b)偏侧化的变化是否与失语的恢复相关，以及c)这些患者是否激活了额外的语言处理和产生区；(3)我们将通过一项先导性研究证明，与传统护理相比，卒中事件发生后一年内接受CIAT治疗对中风后慢性失语的康复具有积极的影响。我们将应用CIAT，并使用功能磁共振成像和神经心理学方法来证明右侧性和非右侧性LMCA卒中患者卒中后语言恢复的临床和解剖相关性之间的关系。公共卫生相关性：项目叙述中风后语言功能丧失(失语症)是中风最可怕的症状之一。语言本质上是人类的一种认知功能。没有它，我们在社会上的社会和经济地位就会受到极大的损害。由于中风而丧失语言能力的高生产力社会成员往往会精神崩溃，可能无法重新进入中风前的社会和职业生活。在这项研究中，我们将研究大脑在从引起失语症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--强制诱导失语疗法的有效性。

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.