Optimizing Targeted Interventions for Aphasia

慢性失语症的语言治疗不能恢复，而语言治疗对心理社会和经济的影响 失语症是毁灭性的。可改变的大脑靶点的知识还没有被利用来催化有意义的治疗结果。经颅直流电刺激(Tdcs)允许系统地研究 大脑靶点参与的影响。Tdcs研究的目的是恢复左脑对语言处理的偏向。TDCs具有很强的临床转化潜力，但它传递给中风的弥散电流 大脑和不受控制的皮质剂量限制了推断的准确性。虽然tDCs可以用来塑造大脑半球对语言的贡献，并研究目标参与，但到目前为止，方法论的方法已经 没有将其用于该目的，阻碍了失语症治疗发展的纵向进展。都是失语症 而tdcs的研究缺乏关于有意义的语言结果和治疗引起的大脑变化的数据。 迫切需要对能够诱使备用脑区进入 适应性参与，以改善功能。未能满足这一需求意味着数以百万计的人 失语症减轻残疾负担的希望微乎其微。长期目标是优化失语症的康复 临床上可翻译的基于大脑的方法。该项目的总体目标是确定如何 诱导功能性语言改善和适应变化，以腾出口才的语言皮质。中心假设是慢性失语症患者的功能性语言结果将在以下情况下得到增强 治疗的重点是将语言加工偏向正常化到左半球。其基本原理是，识别涉及大脑靶点的行为和辅助治疗将允许优化治疗参数，并促进开发新的和个性化的方法，以超越现状和 走向精确的神经康复。在强大的初步数据的指导下，这一假说将通过追求两个具体目标来检验：1)证明靶向右脑调制的增强效应；2) 测量治疗后脑活动的正常化程度。在第一个目标下，语言治疗将是 与活动或假HD-tDCs配对抑制右额下回(三角部)，之后 将测量两组人在叙述和命名方面的收获，并进行比较。在第二个目标下，改变 在EEG中，大脑功能的测量将被表征，并与叙事和命名结果相关。这 贡献将是巨大的，因为预计它将在临床人群中得到广泛应用 将受益于治疗诱导的适应性大脑重组。我们在这个项目上的主要创新是 将一种经过验证的行为治疗方法与有针对性的高清晰度tDC相结合，招募语言网络 (HD-tdcs)，以集中抑制和控制额叶右半球的皮质剂量。这些贡献 对于美国240多万患有失语症的成年人来说，这将是重要的。

Language treatments for chronic aphasia are not restorative, and the psychosocial and economic impacts of aphasia are devastating. Knowledge of modifiable brain targets has not been harnessed to catalyze meaningful treatment outcomes. Transcranial direct current stimulation (tDCS) allows systematic investigations of the effects of brain target engagement. tDCS investigations aim to restore a left hemisphere bias for language processing. tDCS has strong clinical translational potential, but the diffuse current flow it delivers to the stroke brain and uncontrolled cortical dosage limits inferential precision. Although tDCS could be used to shape hemispheric contributions to language and investigate target engagement, methodological approaches so far have not employed it for that purpose, preventing vertical progress in aphasia treatment development. Both aphasia and tDCS research are lacking data on meaningful language outcomes and treatment-induced brain changes. There is a critical need for rigorous investigations of treatments capable of coaxing spared brain areas into adaptive participation for functional improvements. Failure to meet this need means that millions of people with aphasia will have little hope for easing of disability burden. The long-term goal is to optimize aphasia recovery with clinically translatable brain-based approaches. The overall objective of this project is to determine how to induce functional language improvement and adaptive changes to spared eloquent language cortex. The central hypothesis is that functional language outcomes for people with chronic aphasia will be enhanced when treatment focuses on normalizing language processing bias to the left hemisphere. The rationale is that identifying behavioral and adjunctive treatments that engage brain targets will allow optimization of treatment parameters and facilitate the development of novel and personalized approaches to move beyond the status quo and towards precision neurorehabilitation. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Demonstrate the enhancing effect of targeted right hemisphere modulation; and 2) Measure normalization of brain activity following treatment. Under the first aim, language treatment will be paired with active or sham HD-tDCS to inhibit right inferior frontal right gyrus (pars triangularis), after which gains in narrative and naming will be measured and the two groups compared. Under the second aim, changes in EEG measures of brain function will be characterized and related to narrative and naming outcomes. This contribution will be significant because it is expected to have broad application to clinical populations who would benefit from treatment-induced adaptive brain reorganization. Our major innovation for this project is the pairing of a proven behavioral treatment that will recruit language networks with targeted “high-definition” tDCS (HD-tDCS) to focus inhibition and control cortical dosage to the frontal right hemisphere. These contributions will be important for the more than 2.4 million adults in the United States living with aphasia.