Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: behavioral and fMRI outcomes.

PURPOSE This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic aphasia. Whether constraint to the speech modality or treatment intensity is responsible for such gains is still under investigation. Moreover, it remains to be seen whether CIAT is effective in individuals with persistent severe nonfluent speech and/or AOS. METHOD A single-subject multiple-baseline approach was used. Both participants were treated simultaneously, first with Promoting Aphasics' Communicative Effectiveness (PACE; Davis & Wilcox, 1985) and then with CIAT. Pre-/posttreatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to posttreatment phases and maintenance where available. RESULTS Both participants made more and faster gains in naming following CIAT. Treatment-induced changes in BOLD activation suggested that better naming was correlated with the recruitment of perilesional tissue. CONCLUSION Participants produced more target words accurately following CIAT than following PACE. Behavioral and fMRI results support the notion that the intense and repetitive nature of obligatory speech production in CIAT has a positive effect on word retrieval, even in participants with chronic moderate-to-severe aphasia with comorbid AOS.

[1]  H. Goodglass.  Boston diagnostic aphasia examination , 2013 .

[2]  Margaret A. Naeser,et al.  TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia , 2011, Brain and Language.

[3]  Klaus Kayser,et al.  To be at the right place at the right time , 2011, Diagnostic pathology.

[4]  Roy H. Hamilton,et al.  Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation , 2011, Brain and Language.

[5]  P. Turkeltaub,et al.  Are networks for residual language function and recovery consistent across aphasic patients? , 2011, Neurology.

[6]  T. Sanger,et al.  Harnessing neuroplasticity for clinical applications , 2011, Brain : a journal of neurology.

[7]  F. Pulvermüller,et al.  Neuroscience insights improve neurorehabilitation of poststroke aphasia , 2011, Nature Reviews Neurology.

[8]  Agnes Flöel,et al.  Integrity of the hippocampus and surrounding white matter is correlated with language training success in aphasia , 2010, NeuroImage.

[9]  Julius Fridriksson,et al.  Preservation and Modulation of Specific Left Hemisphere Regions is Vital for Treated Recovery from Anomia in Stroke , 2010, The Journal of Neuroscience.

[10]  J. Kurland,et al.  Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke's aphasia , 2010 .

[11]  Loraine K. Obler,et al.  Bilateral brain regions associated with naming in older adults , 2010, Brain and Language.

[12]  Allen R. Braun,et al.  Single-trial fMRI Shows Contralesional Activity Linked to Overt Naming Errors in Chronic Aphasic Patients , 2010, Journal of Cognitive Neuroscience.

[13]  Lynn M. Maher,et al.  Constraint induced language therapy in early aphasia rehabilitation , 2010 .

[14]  L. Fadiga,et al.  Active perception: sensorimotor circuits as a cortical basis for language , 2010, Nature Reviews Neuroscience.

[15]  Cathy J. Price,et al.  Predicting language outcome and recovery after stroke: the PLORAS system , 2010, Nature Reviews Neurology.

[16]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2010 update: a report from the American Heart Association. , 2010, Circulation.

[17]  Grant M. Walker,et al.  Anterior temporal involvement in semantic word retrieval: voxel-based lesion-symptom mapping evidence from aphasia. , 2009, Brain : a journal of neurology.

[18]  A. Papanicolaou,et al.  Behavioral and neurophysiologic response to therapy for chronic aphasia. , 2009, Archives of physical medicine and rehabilitation.

[19]  D. Kempler,et al.  Training verb production in communicative context: Evidence from a person with chronic non‐fluent aphasia , 2009, Aphasiology.

[20]  Agnes Flöel,et al.  Imaging short- and long-term training success in chronic aphasia , 2009, BMC Neuroscience.

[21]  A. Raymer,et al.  Lesion characteristics related to treatment improvement in object and action naming for patients with chronic aphasia , 2009, Brain and Language.

[22]  Yasmeen Faroqi-Shah,et al.  Constraint‐induced language therapy for agrammatism: Role of grammaticality constraints , 2009 .

[23]  F. Pulvermüller,et al.  Memantine and constraint‐induced aphasia therapy in chronic poststroke aphasia , 2009, Annals of neurology.

[24]  R. Hillman,et al.  Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. , 2009, American journal of speech-language pathology.

[25]  K. Baynes,et al.  Implicit phoneme manipulation for the treatment of apraxia of speech and co‐occurring aphasia , 2009 .

[26]  Marcus Meinzer,et al.  Functional imaging studies of treatment‐induced recovery in chronic aphasia , 2008 .

[27]  A. Raymer,et al.  Evidence-based systematic review: effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. , 2008, Journal of speech, language, and hearing research : JSLHR.

[28]  F. Pulvermüller,et al.  Aphasia therapy on a neuroscience basis , 2008, Aphasiology.

[29]  L. Gonzalez-Rothi,et al.  Reliability and validity of the functional outcome questionnaire for aphasia (FOQ-A) , 2008 .

[30]  Thomas Straube,et al.  Association between therapy outcome and right-hemispheric activation in chronic aphasia. , 2008, Brain : a journal of neurology.

[31]  J. Szaflarski,et al.  Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke. , 2008, Medical science monitor : international medical journal of experimental and clinical research.

[32]  Thomas Elbert,et al.  Functional re-recruitment of dysfunctional brain areas predicts language recovery in chronic aphasia , 2008, NeuroImage.

[33]  G. Ramsberger,et al.  Self-administered cued naming therapy: a single-participant investigation of a computer-based therapy program replicated in four cases. , 2007, American journal of speech-language pathology.

[34]  Khader M Hasan,et al.  Changes in Language-specific Brain Activation after Therapy for Aphasia using Magnetoencephalography: A Case Study , 2007, Neurocase.

[35]  Brigitte Rockstroh,et al.  Intensive language training in the rehabilitation of chronic aphasia: Efficient training by laypersons , 2007, Journal of the International Neuropsychological Society.

[36]  Marko Wilke,et al.  LI-tool: A new toolbox to assess lateralization in functional MR-data , 2007, Journal of Neuroscience Methods.

[37]  Bruce Crosson,et al.  Treatment of naming in nonfluent aphasia through manipulation of intention and attention: A phase 1 comparison of two novel treatments , 2007, Journal of the International Neuropsychological Society.

[38]  A. Hillis,et al.  Neural regions essential for distinct cognitive processes underlying picture naming. , 2007, Brain : a journal of neurology.

[39]  Chris Rorden,et al.  Neural correlates of phonological and semantic-based anomia treatment in aphasia , 2007, Neuropsychologia.

[40]  Randall R. Robey,et al.  Evaluating Single-Subject Treatment Research: Lessons Learned from the Aphasia Literature , 2006, Neuropsychology Review.

[41]  J. Wambaugh.  Treatment Guidelines for Apraxia of Speech: Lessons for Future Research , 2006 .

[42]  A. Papanicolaou,et al.  Functional Imaging Before and After Constraint-Induced Language Therapy for Aphasia Using Magnetoencephalography , 2006, Neurocase.

[43]  Vincent Schmithorst,et al.  A combined bootstrap/histogram analysis approach for computing a lateralization index from neuroimaging data , 2006, NeuroImage.

[44]  Diane Kendall,et al.  A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy , 2006, Journal of the International Neuropsychological Society.

[45]  Sophie Schwartz,et al.  Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping , 2006, Journal of the International Neuropsychological Society.

[46]  Jonas Obleser,et al.  Brain regions essential for improved lexical access in an aged aphasic patient: a case report , 2006, BMC neurology.

[47]  A. Thiel,et al.  A proposed regional hierarchy in recovery of post-stroke aphasia , 2006, Brain and Language.

[48]  C. Weiller,et al.  Dynamics of language reorganization after stroke. , 2006, Brain : a journal of neurology.

[49]  David Elliot,et al.  Prostanoid receptor EP1 and Cox-2 in injured human nerves and a rat model of nerve injury: a time-course study , 2006, BMC neurology.

[50]  Kara D. Federmeier,et al.  Timed Action and Object Naming , 2005, Cortex.

[51]  Friedemann Pulvermüller,et al.  Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia , 2005, NeuroImage.

[52]  M. L. Lambon Ralph,et al.  Further explorations and an overview of errorless and errorful therapy for aphasic word-finding difficulties: The number of naming attempts during therapy affects outcome , 2005 .

[53]  B. Rockstroh,et al.  Long-Term Stability of Improved Language Functions in Chronic Aphasia After Constraint-Induced Aphasia Therapy , 2005, Stroke.

[54]  Á. Pascual-Leone,et al.  Improved picture naming in chronic aphasia after TMS to part of right Broca’s area: An open-protocol study , 2005, Brain and Language.

[55]  Harold Goodglass,et al.  Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method , 2004, NeuroImage.

[56]  D. Perani,et al.  A fMRI study of word retrieval in aphasia , 2003, Brain and Language.

[57]  R. Salmelin,et al.  Adult Brain Plasticity Elicited by Anomia Treatment , 2003, Journal of Cognitive Neuroscience.

[58]  T. Elbert,et al.  New treatments in neurorehabiliation founded on basic research , 2002, Nature Reviews Neuroscience.

[59]  Friedemann Pulvermüller,et al.  Syntactic and semantic processing in the healthy and aphasic human brain , 2001, Experimental Brain Research.

[60]  Chris Rorden,et al.  Spatial Normalization of Brain Images with Focal Lesions Using Cost Function Masking , 2001, NeuroImage.

[61]  B. Rockstroh,et al.  Constraint-Induced Therapy of Chronic Aphasia After Stroke , 2001, Stroke.

[62]  E. Kaplan,et al.  Boston Naming Test , 2001 .

[63]  Sébastien Dubé,et al.  Experimental and theoretical evidence for a similar localization of words encoded through different modalities , 1999, Behavioral and Brain Sciences.

[64]  H. E. Brown,et al.  Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: The behavior interleaved gradients technique , 1999, Magnetic resonance in medicine.

[65]  R. R. Robey.  A meta-analysis of clinical outcomes in the treatment of aphasia. , 1998, Journal of speech, language, and hearing research : JSLHR.

[66]  Y. Samson,et al.  Recovery from nonfluent aphasia after melodic intonation therapy , 1996, Neurology.

[67]  J. Duffy.  Motor Speech Disorders: Substrates, Differential Diagnosis, and Management , 1995 .

[68]  N. Miller,et al.  An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. , 1994, Journal of the experimental analysis of behavior.

[69]  Friedemann Pulvermüller,et al.  Behavioral and neoronal changes during treatment of mixed transcortical aphasia: A case study , 1993, Cognition.

[70]  M. Albert,et al.  Severe nonfluency in aphasia. Role of the medial subcallosal fasciculus and other white matter pathways in recovery of spontaneous speech. , 1989, Brain : a journal of neurology.

[71]  M. Wilcox,et al.  Adult Aphasia Rehabilitation: Applied Pragmatics , 1985 .

[72]  W. Tryon,et al.  A simplified time-series analysis for evaluating treatment interventions. , 1982, Journal of applied behavior analysis.

[73]  H. Funkenstein,et al.  Broca aphasia , 1978, Neurology.

[74]  A. Aronson,et al.  Clusters of deviant speech dimensions in the dysarthrias. , 1969, Journal of speech and hearing research.

[75]  A. Aronson,et al.  Differential diagnostic patterns of dysarthria. , 1969, Journal of speech and hearing research.

[76]  D. Mozaffarian,et al.  Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. , 2010, Circulation.

[77]  Argye E. Hillis,et al.  The role of models of language processing in rehabilitation of language impairments , 1993 .

[78]  J. Levin,et al.  Single-case research design and analysis : new directions for psychology and education , 1992 .

[79]  Ronald C. Serlin,et al.  Meta-analysis for single-case research. , 1992 .

[80]  F. Pulvermüller,et al.  Communicative aphasia treatment as a further development of pace therapy , 1991 .

[81]  Sci,et al.  Annals of the New York Academy of Sciences the Anatomy of Language: a Review of 100 Fmri Studies Published in 2009 , 2022 .