Aphasia Recovery Research Articles

Subacute aphasia recovery is associated with resting-state connectivity within and beyond the language network.

To examine changes to connectivity after aphasia treatment in the first 3 months after stroke. Twenty people experiencing aphasia within the first 3 months of stroke completed MRI before and immediately following 15 hours of language treatment. They were classified based on their response to treatment on a naming test of nouns as either high responders (10% improvement or more), or low responders (<10% improvement). Groups were similar in age, gender distribution, education, days since stroke, stroke volume, and baseline severity. Resting-state functional connectivity analysis was limited to the connectivity of the left fusiform gyrus with the bilateral inferior frontal gyrus, supramarginal gyrus, angular gyrus, and superior, middle, and inferior temporal gyrus, based on previous studies showing the importance of left fusiform gyrus in naming performance. Baseline ipsilateral connectivity between the left fusiform gyrus and the language network was similar between high and low responders to therapy when controlling for stroke volume. Following therapy, change in connectivity was significantly greater among high responders between the left fusiform gyrus and the ipsilateral and contralateral pars triangularis, ipsilateral pars opercularis and superior temporal gyrus, and contralateral angular gyrus when compared with low responders. An account of these findings incorporates primarily proximal connectivity restoration, but also potentially reflects select contralateral compensatory reorganization. The latter is often associated with chronic recovery, reflecting the transitional nature of the subacute period.

Cerebral Small Vessel Disease Burden: An Independent Biomarker for Anomia Treatment Responsiveness in Chronic Stroke Patients With Aphasia

ObjectiveTo determine whether MRI-based cerebral small vessel disease (cSVD) burden predicts treatment-induced aphasia recovery in chronic stroke patients above and beyond initial aphasia severity and stroke-lesion volume. DesignRetrospective. Four cSVD neuroimaging markers were rated using validated visual scales: white matter hyperintensities, enlarged perivascular spaces, lacunes, and global cortical atrophy. We also calculated a cSVD total score. We employed linear regression models to model treatment response as a function of cSVD burden. We also ran correlation analyses to determine the association among cSVD burden and pre-treatment linguistic and non-linguistic cognition. SettingResearch clinic. ParticipantsThe study includes data from 30 chronic stroke patients with aphasia who received treatment for word finding difficulties and completed additional pre-treatment neuroimaging and behavioral assessments (N=30). Interventions120-minute sessions of anomia treatment 2 times per week for up to 12 weeks. Main Outcome MeasuresChange in accuracy on the treatment probes measured as a percentage (ie, change in accuracy percentage score=post-treatment accuracy percentage minus pre-treatment accuracy percentage). ResultsBaseline cSVD burden predicted response to anomia treatment independently from demographic and stroke-related factors. Patients with lower cSVD burden exhibited enhanced rehabilitation response compared with those with higher cSVD burden (β=-6.816e-02, P=.019). cSVD burden was highly associated with nonverbal executive function at baseline (r=-0.49, P=.005): patients with lower cSVD burden exhibited higher performance on nonverbal executive function tasks compared with participants with higher cSVD burden. No association was observed among cSVD burden and performance on language tasks at the baseline. ConclusionscSVD, a marker of brain reserve and a robust risk factor for post-stroke dementia, may be used as a biomarker for distinguishing patients who are more likely to respond to anomia therapy from those who are less likely to do so and for individualizing treatment parameters (eg, targeting both linguistic and nonlinguistic cognition in severe cSVD).

Progress in the clinical application of constraint-induced therapy following stroke since 2014.

Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders, which may reduce the quality of life among the patients. Constraint-induced therapy has been proven to be an effective treatment method for stroke rehabilitation. It has been widely used in the recovery of limb motor dysfunction, aphasia, and other impairment like unilateral neglect after stroke. In recent years, constraint-induced therapy can also combine with telehealth and home rehabilitation. In addition, constraint-induced therapy produces significant neuroplastic changes in the central nervous system. Functional magnetic resonance imaging, diffusion tensor imaging, and other imaging/electrophysiology methods have been used to clarify the mechanism and neuroplasticity. However, constraint-induced therapy has some limitations. It can only be used under certain conditions, and the treatment time and effectiveness are controversial. Further research is needed to clarify the mechanism and effectiveness of CI therapy.

Do social determinants influence post-stroke aphasia outcomes? A scoping review

Purpose To conduct a scoping review on five individual social determinants of health (SDOHs): gender, education, ethnicity, socioeconomic status, and social support, in relation to post-stroke aphasia outcomes. Materials and methods A comprehensive search across five databases was conducted in 2020 and updated in 2022. Twenty-five studies (3363 participants) met the inclusion criteria. Data on SDOHs and aphasia outcomes were extracted and analysed descriptively. Results Twenty studies provide information on SDOH and aphasia recovery outcomes. Five studies provide insights on SDOH and response to aphasia intervention. Research on SDOH and aphasia recovery has predominantly focussed solely on language outcomes (14 studies), with less research on the role of SDOH on activity, participation, and quality of life outcomes (6 studies). There is no evidence to support a role for gender or education on language outcomes in the first 3 months post stroke. SDOHs may influence aphasia outcomes at or beyond 12 months post onset. Conclusions Research on SDOHs and aphasia outcomes is in its infancy. Given SDOHs are modifiable and operate over a lifetime, and aphasia is a chronic condition, there is a pressing need to understand the role of SDOHs on aphasia outcomes in the long term.

Diabetes, brain health, and treatment gains in post-stroke aphasia.

In post-stroke aphasia, language improvements following speech therapy are variable and can only be partially explained by the lesion. Brain tissue integrity beyond the lesion (brain health) may influence language recovery and can be impacted by cardiovascular risk factors, notably diabetes. We examined the impact of diabetes on structural network integrity and language recovery. Seventy-eight participants with chronic post-stroke aphasia underwent six weeks of semantic and phonological language therapy. To quantify structural network integrity, we evaluated the ratio of long-to-short-range white matter fibers within each participant's whole brain connectome, as long-range fibers are more susceptible to vascular injury and have been linked to high level cognitive processing. We found that diabetes moderated the relationship between structural network integrity and naming improvement at 1month post treatment. For participants without diabetes (n = 59), there was a positive relationship between structural network integrity and naming improvement (t = 2.19, p = 0.032). Among individuals with diabetes (n = 19), there were fewer treatment gains and virtually no association between structural network integrity and naming improvement. Our results indicate that structural network integrity is associated with treatment gains in aphasia for those without diabetes. These results highlight the importance of post-stroke structural white matter architectural integrity in aphasia recovery.

Aphasia and friendship: Stroke survivors’ self-reported changes over time

IntroductionFriendships are an important contributor to quality of life. Due to communication and other stroke-related challenges, people with aphasia (PWA) can experience negative friendship changes, which have been linked with increased physiological distress. This study examined friendship experiences over time for PWA to understand how friendships evolve throughout the course of stroke and aphasia recovery. MethodsFifteen stroke survivors with chronic aphasia completed language testing and a friendship questionnaire created by the researchers. The friendship questionnaire was composed of open and closed-ended questions that asked PWA to reflect back on their friendship satisfaction, support, activities, and communication during the time before aphasia and during the acute stage of recovery. The questionnaire also addressed their current friendships in the present-day chronic stage of recovery, as well as questions about an ideal friendship. Quantitative and qualitative methods were used to examine the data, with quantitative findings reported in this study. ResultsThe majority of PWA reported maintaining some friendships and developing new friendships, often with a fellow stroke survivor with aphasia; however, a few PWA in this study were not able to maintain or develop any new friendships. Average ratings of perceived friendship satisfaction and support improved from the acute to chronic stage, nearing those of the ratings pre-stroke, yet there was greater variability in the chronic stage with some currently feeling dissatisfied and not well supported. Aphasia severity, as measured by a standardized assessment, had a negative relationship with perceived friendship support. In contrast, perception of communicative participation had a positive relationship with friendship support. ConclusionsThis work highlights lasting social implications of aphasia. The overall health of PWA deserves greater attention, including interventions targeting friendship maintenance and development. Continued stakeholder-engaged research and clinical practice focused on the social and emotional consequences of aphasia on PWA, as well as their friends and family, is needed to assist all involved in aphasia recovery achieve better friendships and well-being.

Possible Effects of Acupuncture in Poststroke Aphasia.

Neural plasticity promotes the reorganization of language networks and is an essential recovery mechanism for poststroke aphasia (PSA). Neuroplasticity may be a pivotal bridge to elucidate the potential recovery mechanisms of acupuncture for aphasia. Therefore, understanding the neuroplasticity mechanism of acupuncture in PSA is crucial. However, the underlying therapeutic mechanism of neuroplasticity in PSA after acupuncture needs to be explored. Excitotoxicity after brain injury affects the activity of neurotransmitters and disrupts the transmission of normal neuron information. Thus, a helpful strategy of acupuncture might be to improve PSA by affecting the availability of these neurotransmitters and glutamate receptors at synapses. In addition, the regulation of neuroplasticity by acupuncture may also be related to the regulation of astrocytes. Considering the guiding significance of acupuncture for clinical treatment, it is necessary to carry out further study about the influence of acupuncture on the recovery of aphasia after stroke. This study summarizes the current research on the neural mechanism of acupuncture in treating PSA. It seeks to elucidate the potential effect of acupuncture on the recovery of PSA from the perspective of synaptic plasticity and integrity of gray and white matter.

Consistent long-term practice leads to consistent improvement: Benefits of self-managed therapy for language and cognitive deficits using a digital therapeutic.

Although speech-language therapy (SLT) is proven to be beneficial to recovery of post-stroke aphasia, delivering sufficiently high amounts of dosage remains a problem in real-world clinical practice. Self-managed SLT was introduced to solve the problem. Previous research showed in a 10-week period, increased dosage frequency could lead to better performance, however, it is uncertain if dosage still affects performance over a longer period of practice time and whether gains can be seen following practice over several months. This study aims to evaluate data from a health app (Constant Therapy) to investigate the relationship between dosage amount and improvements following a 30-week treatment period. Two cohorts of users were analyzed. One was comprised of patients with a consistent average weekly dosage amount and the other cohort was comprised of users whose practice had higher variability. We conducted two analyses with two cohorts of post-stroke patients who used Constant Therapy. The first cohort contains 537 "consistent" users, while the second cohort contains 2,159. The 30-week practice period was split into three consecutive 10-week practice windows to calculate average dosage amount. In each 10-week practice period, patients were grouped by their average dosage into low (0-15 min/week), medium (15-40 min/week) and moderate dosage (greater than 40 min/week) groups. Linear mixed-effects models were employed to evaluate if dosage amount was a significant factor affecting performance. Pairwise comparison was also applied to evaluate the slope difference between groups. For the consistent cohort, medium (β = .002, t 17,700 = 7.64, P < .001) and moderate (β = .003, t 9,297 = 7.94, P < .001) dosage groups showed significant improvement compared to the low dosage group. The moderate group also showed greater improvement compared to the medium group. For the variable cohort in analysis 2, the same trend was shown in the first two 10-week windows, however, in weeks 21-30, the difference was insignificant between low and medium groups (β = .001, t = 1.76, P = .078). This study showed a higher dosage amount is related to greater therapy outcomes in over 6 months of digital self-managed therapy. It also showed that regardless of the exact pattern of practice, self-managed SLT leads to significant and sustained performance gains.

Правое полушарие и восстановление речи при постинсультной афазии

&lt;p style="text-align: justify;"&gt;The analytical review presents the clinical, neurobiological, and neuropsychological aspects of post-stroke aphasia as well as the role of the right hemisphere in speech recovery. The paper shows the influence of size, topography, lesion depth, cerebral hemodynamic plasticity, initial morphometric characteristics of the brain, and handedness on the functional recovery of aphasia. The review considers the typology and mechanisms of the appearance of "stealing symptoms" of homologous and non-homologous regions of the intact hemisphere. The "low-level" and "high-level" models of language competence of the right hemisphere are analyzed. The study describes the topography of the brain activation regions in the intact hemisphere during various speech task-solving. The paper shows the heterochrony between impressive and expressive speech recovery in aphasics and its bilateral inter-lateral distribution. The authors conclude that to clarify the mechanisms of aphasia recovery, it is necessary for a comprehensive account of clinical, neurobiological and neuropsychological patterns of speech disorder reparation in different post-stoke epochs. The paper notices that a deeper understanding of the impact of structural and functional repairment of speech processes on the aphasia outcome, it needs to assess the relationship between the degree of speech disorders reduction and the lateral vector of speech architectonics in the post-stroke period.&lt;/p&gt;

The right uncinate fasciculus supports verbal short-term memory in aphasia

Verbal short-term memory (STM) deficits are associated with language processing impairments in people with aphasia. Importantly, the integrity of STM can predict word learning ability and anomia therapy gains in aphasia. While the recruitment of perilesional and contralesional homologous brain regions has been proposed as a possible mechanism for aphasia recovery, little is known about the white-matter pathways that support verbal STM in post-stroke aphasia. Here, we investigated the relationships between the language-related white matter tracts and verbal STM ability in aphasia. Nineteen participants with post-stroke chronic aphasia completed a subset of verbal STM subtests of the TALSA battery including nonword repetition (phonological STM), pointing span (lexical-semantic STM without language output) and repetition span tasks (lexical-semantic STM with language output). Using a manual deterministic tractography approach, we investigated the micro- and macrostructural properties of the structural language network. Next, we assessed the relationships between individually extracted tract values and verbal STM scores. We found significant correlations between volume measures of the right Uncinate Fasciculus and all three verbal STM scores, with the association between the right UF volume and nonword repetition being the strongest one. These findings suggest that the integrity of the right UF is associated with phonological and lexical-semantic verbal STM ability in aphasia and highlight the potential compensatory role of right-sided ventral white matter language tracts in supporting verbal STM after aphasia-inducing left hemisphere insult.

Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke

Background White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. Objective To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. Methods Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. Results The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = −3.00, p = .004) and chronic (t = −3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. Conclusions Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.

The longitudinal trajectory of discourse from the hyperacute to the chronic phase in mild to moderate poststroke aphasia recovery: A case series study.

Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24h; acute: 24-72h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia. What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.

Effects of the Left M1 iTBS on Brain Semantic Network Plasticity in Patients with Post-Stroke Aphasia: A Preliminary Study.

The left primary motor area (M1) stimulation has recently been revealed to promote post-stroke aphasia (PSA) recovery, of which a plausible mechanism might be the semantic and/or the mirror neuron system reorganization, but the direct evidence is still scarce. The aim of this study was to explore the functional connectivity (FC) alterations induced by the left M1 intermittent theta burst stimulation (iTBS), a new transcranial magnetic stimulation paradigm, in the semantic and mirror neuron systems of PSA patients. Sixteen PSA patients accepted the left M1 iTBS and underwent a resting-state functional magnetic resonance image (fMRI) scanning before and immediately after the first session of iTBS, of which six underwent another fMRI scanning after twenty sessions of iTBS. Three brain networks covering the semantic and the mirror neuron systems were constructed using the fMRI data, and the FC alterations following one-session iTBS were investigated in the networks. Additional seed-based FC analyses were conducted to explore the longitudinal FC patterns changes during the course of multi-session iTBS. The Aphasia quotient of the Chinese version of the western aphasia battery (WAB-AQ) was used to assess the severity of the language impairments of the participants. The relationship between the longitudinal WAB-AQ and network FC changes was analyzed by Spearman's correlation coefficients in the multi-session iTBS sub-group. Decreased FCs were noted in the bilateral semantic rather than in the mirror neuron networks following one-session of iTBS (p < 0.05, network based statistical corrected). Longitudinal seed-based FC analyses revealed changing FC ranges along the multi-session iTBS course, extending beyond the semantic networks. No significant relationship was found between the longitudinal WAB-AQ and network FC changes in the multi-session iTBS sub-group. The left M1 iTBS might induce FC changes in the semantic system of PSA patients. This research was registered on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn/index.aspx), and the registration number is ChiCTR2100041936.

Post-stroke aphasia recovery: what are the predictors?

Post-stroke aphasia recovery is multifactorial and results from a complex equation between four types of interrelated factors : a) neurobiological factors, such as lesion size and location, but also to some extent the neural reserve in undamaged brain areas ; b) behavioral factors, mostly related to the initial severity of stroke symptoms ; c) personal factors, such as age and gender, that remain however poorly investigated and debated and d) therapeutic factors, related to medical endovascular interventions and to speech and language therapy. Future studies are crucial to determine more precisely the weight and the interaction of these factors in the recovery process of post-stroke aphasia.

Assessments of Aphasia: Practices and Challenges faced by Malaysian Speech-Language Therapists

Aphasia assessment is crucial in diagnosing aphasia, determining the extent of language impairment, and identifying factors that may support or restrict aphasia recovery to design an appropriate plan of care for people with aphasia. Speech-language therapists (SLTs) play a major role in conducting aphasia assessments. Little is known about the practices of SLTs in assessing aphasia in low-resource regions. The present study aims to identify aphasia assessment practices among Malaysian SLTs and related challenges, as well as strategies for improving aphasia assessments from SLTs’ perspectives. A total of 32 SLT participants who have been practicing in Malaysia completed an online survey to gather their background information, data pertaining to practices and challenges in conducting aphasia assessments, and suggestions for improving aphasia assessments. Descriptive analyses were conducted for all numerical data. Suggestions for improving aphasia assessment practices were analysed qualitatively using the thematic content analysis approach. SLT practices in aphasia assessment were found to be consistent in certain aspects, but not all. Two major challenges were identified: (a) linguistic barriers between clinicians and clients/caregivers, and (b) a lack of standardized assessment tools for aphasia evaluations. Participants suggested “Internal Strategies” and “External Strategies” for improving aphasia assessment practices. Keywords:aphasia; clinical practices; Malaysia; speech-language therapists

Examining Dose Frameworks to Improve Aphasia Rehabilitation Research

The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research—the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.

Constraint-Induced Language Therapy for Aphasia: Evidence from Systematic Reviews and Meta-Analyses

<h3>Objective(s)</h3> Constraint induced language therapy (CILT) is an aphasia treatment that incorporates use-dependent principles to facilitate language recovery in stroke-induced aphasia (Pulvermuller et al., 2001). Several systematic reviews (SR) have been conducted to summarize the growing CILT literature. The purpose of this project was to appraise the quality and examine the weight of treatment evidence reported in CILT SRs. <h3>Data Sources</h3> PsychInfo, PubMed, SpeechBite, ASHA Compendium of Systematic Reviews. <h3>Study Selection</h3> We identified six SRs that examined CILT for post-stroke aphasia in the English literature, three that included meta-analysis (MA). <h3>Data Extraction</h3> Two reviewers rated each SR for methodologic quality using the AMSTAR2 (Shea et al., 2017) and extracted findings across the six reviews. Coding reliability for the AMSTAR2 showed 94.8% agreement. <h3>Data Synthesis</h3> The quality of SRs varied on the AMSTAR2 scale (range 1.5-9.5, mean 7/16). Five SRs addressed more than half of the appraisal criteria. The number of original studies included in the SRs ranged from 5 to 24, as some reviews included only RCTs and others included all designs. CILT SRs that included all designs reported positive CILT outcomes, particularly for trained naming stimuli. Two MAs that analyzed RCTs reported limited positive outcomes for standardized language measures. <h3>Conclusions</h3> Conclusions varied as descriptive SR summaries reported positive effects of CILT studies, yet MA showed that effects often did not surpass comparison treatments for naming, comprehension, and repetition. Early enthusiasm has given way to measured caution in recent MAs that have summarized CILT outcomes relative to control treatments of similar intensity, suggesting that the intensity effect may be the more potent factor than verbal constraint in the reported CILT results. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to report.

Outcomes from a pilot dose comparison study of naming therapy in aphasia

ABSTRACT Background People with aphasia vary considerably in response to aphasia treatments. Treatment dose is likely to be an important factor in understanding treatment response variability and optimising aphasia recovery; however, there is limited empirical evidence to guide dose prescription in post-stroke aphasia rehabilitation. In the present study, we used a novel approach to personalise dose prescription and explored the effect of dose on treatment response in chronic post-stroke aphasia. Aims Examine the effect of providing personalised doses of a cued picture naming treatment (Kendall et al., 2014) on acquisition and maintenance of picture naming outcomes. Method This pilot study used a multiple-baselines design with follow-up at 4- and 12-weeks with replication across four people with chronic post-stroke anomia. Prior to treatment, a comprehensive battery of cognitive and language tests was completed. Participants then undertook a period of cued picture naming treatment (45-minute sessions, five days per week for three weeks) totalling 15 sessions (11.25 hours). Participants were allocated four picture sets – one each for three treated conditions (low dose, moderate dose, and high dose) and one for an untreated control set. The number of naming opportunities provided per dose condition was calibrated against individuals’ pre-treatment picture naming accuracy and speed. Generalised linear mixed effects models were used to evaluate learning effects during treatment, maintenance of these effects, and dose-response relationships. Outcomes Participants received 99% of prescribed treatment doses (i.e., number of naming opportunities provided over the course of treatment). As anticipated, individual treatment responses varied substantially. Three participants demonstrated significantly improved picture naming accuracy on probed items during treatment, with varying response profiles by participant and dose. All participants were able to name more pictures accurately on a bespoke 298-item object picture naming test following treatment. However, no participant demonstrated significant pre-post treatment gains relative to untreated items, although one person demonstrated improved naming four weeks after treatment for items treated under the high dose condition. Dose-response relationships amongst these participants exhibited a greater number of significant results on naming probes in the high dose condition, possibly suggesting superiority of the high dose condition over lower doses of cued picture naming treatment. Conclusion Modest treatment effects and variable dose-response relationships were observed. We explore the role of dose, cognitive factors such as self-monitoring abilities, and linguistic factors such as underlying lexical-semantic and phonological processing that may have influenced treatment response in these participants. Avenues for future research are identified.

O042 / #987 EXAMINING THREE TDCS MONTAGES COMBINED WITH APHASIA THERAPY TO IMPROVE NAMING IN POST-STROKE APHASIA: A MULTI-SITE STUDY: TRACK 3: RESTORATIVE THERAPIES / NONINVASIVE STIMULATION / NEUROSTIMULATION FOR HEAD AND FACE PAIN

Aphasia is a devastating acquired language disorder that affects about one third of stroke survivors. Aphasia can severely affect quality of life and can be associated with economic burdens due to the need for long-term communication rehabilitation. Traditional aphasia therapies can be effective; however, progress is often slow and limited in severe cases. Transcranial direct current stimulation (tDCS) is a non-invasive and inexpensive neuromodulation technique that has the potential to boost language recovery in post-stroke aphasia and reduce rehabilitation duration compared to traditional therapies alone.

French Phonological Component Analysis and aphasia recovery: A bilingual perspective on behavioral and structural data.

Studies show bilingualism entails an advantage in cognitive control tasks. There is evidence of a bilingual advantage in the context of aphasia, resulting in better cognitive outcomes and recovery in bilingual persons with aphasia compared to monolingual peers. This bilingual advantage also results in structural changes in the right hemisphere gray matter. Very few studies have examined the so-called bilingual advantage by reference to specific anomia therapy efficacy. This study aims to compare the effect of French-Phonological Component Analysis (Fr-PCA) in monolinguals and bilingual persons with aphasia, both at the linguistic and cognitive control level, and to examine the structural impact of left hemisphere lesion location and right hemisphere structural data. Eight participants with chronic aphasia received Fr-PCA for a total of 15 h over 5 weeks. The results showed improved accuracy for treated words and generalization to untreated items and discourse in both groups, and improved Flanker task performance for some participants. Bilingual participants improved more than monolinguals for picture-naming tasks and narrative discourse. Damage to the left postcentral gyrus and the middle frontal gyrus was associated with less therapy-induced improvement. Additionally, left hemisphere damage to the inferior parietal gyrus and postcentral gyrus was associated with reduced cognitive control pre-therapy. Undamaged right hemisphere cortical thicknesses were significantly different between groups; the inferior frontal gyrus and the middle frontal gyrus were greater for the bilingual participants and correlated with cognitive control skills. These results suggest a bilingual advantage in anomia recovery following Fr-PCA, potentially resulting from enhanced cognitive control abilities that could be supported by right hemisphere neural reserve.