Compensatory Reorganization Compensatory Reorganization in Recovery from Aphasia in Recovery from Aphasia after Stroke after Stroke Bruce Crosson, Ph.D. Bruce Crosson, Ph.D. Brain Rehabilitation Research Center Brain Rehabilitation Research Center Malcom Randall VA Medical Center Malcom Randall VA Medical Center and and Department of Clinical & Health Psychology Department of Clinical & Health Psychology University of Florida University of Florida Gainesville, Florida Gainesville, Florida Only published work or work presented at meetings is included in these Only published work or work presented at meetings is included in these
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Compensatory Reorganization in Recovery from Aphasia after Stroke Bruce Crosson, Ph.D. Brain Rehabilitation Research Center Malcom Randall VA Medical Center.
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Compensatory Reorganization in Compensatory Reorganization in Recovery from Aphasia after StrokeRecovery from Aphasia after Stroke
Bruce Crosson, Ph.D.Bruce Crosson, Ph.D.
Brain Rehabilitation Research CenterBrain Rehabilitation Research CenterMalcom Randall VA Medical CenterMalcom Randall VA Medical Center
andandDepartment of Clinical & Health PsychologyDepartment of Clinical & Health Psychology
University of FloridaUniversity of FloridaGainesville, FloridaGainesville, Florida
Only published work or work presented at meetings is included in these slides.Only published work or work presented at meetings is included in these slides.
CollaboratorsCollaborators RehabilitationRehabilitationLeslie Gonzalez Rothi, Ph.D.Leslie Gonzalez Rothi, Ph.D.Katherine S. Richards, M.S.Katherine S. Richards, M.S.Christina E. Wierenga, M.S.Christina E. Wierenga, M.S.M. Allison Cato, Ph.D.M. Allison Cato, Ph.D.Flo Singletary, M.A.Flo Singletary, M.A.Maribel Ciampiti, M.A.Maribel Ciampiti, M.A.Beth Holliway, M.A.Beth Holliway, M.A.Amy Rodriguez, M.A.Amy Rodriguez, M.A.Susan Leon, M.A.Susan Leon, M.A.Cynthia Beaulieu, Ph.D.Cynthia Beaulieu, Ph.D.R. Bruce Parkinson, M.S.R. Bruce Parkinson, M.S.Megan E. Gaiefsky, M.S.Megan E. Gaiefsky, M.S.Anastasia M. Raymer, Ph.D.Anastasia M. Raymer, Ph.D.Lynn M. Maher, Ph.D.Lynn M. Maher, Ph.D.Tim W. Conway, Ph.D.Tim W. Conway, Ph.D.
NeuroImagingNeuroImagingRichard W. Briggs, Ph.D.Richard W. Briggs, Ph.D.Keith D. White, Ph.D.Keith D. White, Ph.D.Anna Bacon Moore, Ph.D.Anna Bacon Moore, Ph.D.Megan Gaiefsky, M.S.Megan Gaiefsky, M.S.Kaundinya Gopinath, Ph.D.Kaundinya Gopinath, Ph.D.Tim W. Conway, Ph.D.Tim W. Conway, Ph.D.K. K. Peck, Ph.D.K. K. Peck, Ph.D.David Soltysik, Ph.D.David Soltysik, Ph.D.Christina MilstedChristina MilstedMichelle Benjamin, M.S.Michelle Benjamin, M.S.Keith McGregorKeith McGregorR. Bruce Parkinson, M.S.R. Bruce Parkinson, M.S.Ashley WabnitzAshley WabnitzTrista PerezTrista PerezYu-ling Chang, M.S.Yu-ling Chang, M.S.Ashley OrynichAshley Orynich
Funding SourcesFunding Sources
NIDCD #P50 DC03888NIDCD #P50 DC03888Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard
Briggs Imaging Core PIsBriggs Imaging Core PIs
VA RR&D #VA RR&D #F2182CF2182CLeslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core
CoordinatorCoordinator
VA RR&D #VA RR&D #B3470SB3470S Bruce Crosson, PI (Research Career Scientist)Bruce Crosson, PI (Research Career Scientist)
VA RR&D #C2602V VA RR&D #C2602V Anna Moore, PI (Research Career Development Award)Anna Moore, PI (Research Career Development Award)
VA RR&D ##B3480HVA RR&D ##B3480HTim W. Conway, PI (Associate Investigator Award)Tim W. Conway, PI (Associate Investigator Award)
1.1. RECOVERY: Does reorganization of function RECOVERY: Does reorganization of function occur primarily in perilesional cortex of the occur primarily in perilesional cortex of the dominant hemisphere (left) or in the previously dominant hemisphere (left) or in the previously nondominant (right) hemisphere?nondominant (right) hemisphere?
2.2. REHAB: Does rehabilitation influence the REHAB: Does rehabilitation influence the hemisphere to which language reorganizes?hemisphere to which language reorganizes?
Reorganization of Language in Aphasia:Reorganization of Language in Aphasia:Left or Right Hemisphere?Left or Right Hemisphere?
Review from: Crosson, B. (in press). Functional neuroimaging of
impaired language: Aphasia. In Hillary & DeLuca (eds.) Functional Neuroimaging in Clinical Populations. New York: Guilford.
Good RecoveryGood Recovery: small lesions, greater perilesional than right-: small lesions, greater perilesional than right-hemisphere reorganization hemisphere reorganization
Poor RecoveryPoor Recovery: large lesions, greater right-hemisphere than : large lesions, greater right-hemisphere than perilesional reorganization perilesional reorganization
ReferencesReferences: Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al., : Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al.,
1998; Perani et al., 2003; Rosen et al., 20001998; Perani et al., 2003; Rosen et al., 2000
Role of Intention / Attention Mechanisms in ReorganizationRole of Intention / Attention Mechanisms in Reorganization
Anterior lesion with intact basal ganglia:Anterior lesion with intact basal ganglia: Reorganization of language Reorganization of language production to the right frontal lobe production to the right frontal lobe
Anterior + basal ganglia lesion:Anterior + basal ganglia lesion: Bilateral frontal activity during Bilateral frontal activity during language production language production
ReferenceReference: (Kim et al., 2002).: (Kim et al., 2002).
Object naming improvement vs. basal Object naming improvement vs. basal ganglia (N=13)ganglia (N=13)
Action naming improvement vs. basal Action naming improvement vs. basal ganglia (N=12)ganglia (N=12)
Correlations between Naming ImprovementCorrelations between Naming Improvementand Basal Ganglia Lesion Extentand Basal Ganglia Lesion Extent::
Partial Correlations Controlling for Anterior Cortical Lesion ExtentPartial Correlations Controlling for Anterior Cortical Lesion Extent
Parkinson et al., POSTER: 11 – 12:30 Saturday
Hypotheses about Basal GangliaHypotheses about Basal Ganglia
Basal ganglia involved in suppression of behavior / cognition Basal ganglia involved in suppression of behavior / cognition
Damaged anterior language production mechanisms produce Damaged anterior language production mechanisms produce noisy output, hampering productionnoisy output, hampering production
Anterior lesion vs. Anterior lesion vs. object naming object naming improvement (N=13)improvement (N=13)
.858.858 <.0005<.0005
Anterior lesion vs. Anterior lesion vs. action naming action naming improvement (N=12)improvement (N=12)
.821.821 .002.002
Correlations between Naming Improvement and Cortical Lesion Extent:Correlations between Naming Improvement and Cortical Lesion Extent:Partial Correlation Controlling for Basal Ganglia Lesion ExtentPartial Correlation Controlling for Basal Ganglia Lesion Extent
Parkinson et al., POSTER: 11 – 12:30 Saturday
Small LesionSmall Lesion
Perilesional Reorganization Optimal:Perilesional Reorganization Optimal:L Hemisphere Best SubstrateL Hemisphere Best Substrate
Perilesional Activity “Noisy”Perilesional Activity “Noisy”Competes with R HemisphereCompetes with R Hemisphere
Perilesional Activity Impossible:Perilesional Activity Impossible:R Hemisphere Best SubstrateR Hemisphere Best Substrate
Critical Cortex Lesion Size and Perilesional ActivityCritical Cortex Lesion Size and Perilesional Activity
ChronicAphasiaCases
Large LesionLarge Lesion
It may be possible to influence the hemisphere in which It may be possible to influence the hemisphere in which language functions are performed through treatmentlanguage functions are performed through treatment
Activity in right-hemisphere homologues of damaged left-Activity in right-hemisphere homologues of damaged left-hemisphere language cortex can be critical for rehabilitationhemisphere language cortex can be critical for rehabilitation
ReferenceReference: Musso et al., 1999: Musso et al., 1999
Reactivating intact left-hemisphere language cortex can Reactivating intact left-hemisphere language cortex can also be critical in rehabilitationalso be critical in rehabilitation
G01 Outcome:G01 Outcome:Improved word order Improved word order in sentences with in sentences with generalization to generalization to narrative samplenarrative sample
J02 Outcome:J02 Outcome:Improved word order Improved word order in sentences with no in sentences with no generalization to generalization to narrative samplenarrative sample
Syntactic Mapping TreatmentSyntactic Mapping Treatment(fMRI Task: Active Sentence Generation from Picture)(fMRI Task: Active Sentence Generation from Picture)
Wierenga et al. (in press) Journal of the International
1.1. Both the left and right hemispheres participate in Both the left and right hemispheres participate in recovery from and rehabilitation for aphasia. The recovery from and rehabilitation for aphasia. The degree of right vs. left participation depends on degree of right vs. left participation depends on the patient, the size of the lesion, the location of the patient, the size of the lesion, the location of the lesion, and the language function in question.the lesion, and the language function in question.
2.2. It may be possible to manipulate intentional It may be possible to manipulate intentional mechanisms to change the hemisphere from mechanisms to change the hemisphere from which language production is performed if that is which language production is performed if that is desirable.desirable.
3.3. Activity in a structure (in the left or right Activity in a structure (in the left or right hemisphere) during functional neuroimaging hemisphere) during functional neuroimaging tasks does not mean it is making a positive tasks does not mean it is making a positive contribution to performance.contribution to performance.
Posters, bibliography, and slides of completed work at Posters, bibliography, and slides of completed work at www.BIRC.phhp.ufl.eduwww.BIRC.phhp.ufl.edu