MRI neuroimaging: language recovery in adult aphasia due to stroke
Martin, Paula Irene
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This research focuses on the contribution of magnetic resonance imaging (MRI) to understanding recovery and treatment of aphasia in adults who have suffered a stroke. There are three parts. Part 1 presents the feasibility of the application of an overt, picture-naming, functional MRI (fMRI) paradigm to examine neural activity in chronic, nonfluent aphasia (four mild-moderate and one severe nonfluent/global patient). The advantages and disadvantages of an overt, object picture-naming, fMRI block-design paradigm are discussed. An overt naming fMRI design has potential as a method to provide insight into recovery from adult aphasia including plasticity of the brain after left hemisphere stroke and response to treatment. Part 2 uses the overt naming fMRI paradigm to examine changes in neural activity (neural plasticity) after a two-week series of repetitive transcranial magnetic stimulation (rTMS) treatments to improve picture naming in chronic nonfluent aphasia. An overview of rTMS and rationale for use of rTMS as a clinical treatment for aphasia is provided. Patterns of fMRI activation are examined in two patients with chronic nonfluent aphasia following a two-week series of 1 Hz rTMS treatments to suppress the right pars triangularis portion of the right hemisphere, Broca's homologue. One patient responded well, and the other did not. Differences in fMRI activation in response to the rTMS treatment for the two patients may be due to differences in the patients' lesion sites and extent of damage within each lesion site. Part 3 examines the area of the corpus callosum (CC) in 21 chronic nonfluent aphasia patients and 13 ageequivalent controls using structural MRI. Understanding brain morphology and potential atrophy of the CC in chronic stroke patients may shed light on alterations in the interhemispheric dynamics after stroke, especially patterns of brain reorganization during post-stroke language recovery. A decrease in interhemispheric connections has implications for mechanisms of language recovery and potential success with specific treatment methods. Future directions of both structural and functional neuroimaging to study language recovery in adult aphasia are discussed.
Thesis (Ph.D.)--Boston University