Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
Highlights
Stroke affects 15 million people worldwide and approximately 800,000 people in the United States, with an estimated one third (35%) of stroke survivors left with aphasia in the chronic stage [2]
With advances in neuroimaging and other technologies, a large literature has emerged in the past two decades focused on the brain and language recovery, adding substantially to what we know, challenging early ideas about aphasia recovery and providing early and promising results for neuroplasticity in chronic stroke survivors
With respect to language recovery, Hillis found that damage to left posterior superior temporal gyrus and fibers that included superior longitudinal fasciculus and arcuate fasciculus negatively influenced the degree of recovery of naming skills [33] in acute and chronic patients with aphasia, and these findings were independent of total lesion volume
Summary
Stroke affects 15 million people worldwide and approximately 800,000 people in the United States, with an estimated one third (35%) of stroke survivors left with aphasia in the chronic stage [2]. Post-stroke aphasia significantly negatively impacts quality of life [3, 4] and has a greater negative effect than other common diseases such as cancer, Alzheimer’s and Parkinson’s disease [5]. It is important that research advances our understanding of ways to alleviate the social isolation and lack of autonomy in individuals with aphasia. With advances in neuroimaging and other technologies, a large literature has emerged in the past two decades focused on the brain and language recovery, adding substantially to what we know, challenging early ideas about aphasia recovery and providing early and promising results for neuroplasticity in chronic stroke survivors. In this paper we review this work, emphasizing that the age-old nature, nurture dichotomy extends to recovery from aphasia
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