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Studies of patients with acquired cognitive deficits following brain damage and studies using contemporary neuroimaging techniques form two distinct streams of research on the neural basis of cognition. In this study, we combine high-quality structural neuroimaging analysis techniques and extensive behavioural assessment of patients with persistent acquired language deficits to study the neural basis of language. Our results reveal two major divisions within the language system—meaning versus form and recognition versus production—and their instantiation in the brain. Phonological form deficits are associated with lesions in peri-Sylvian regions, whereas semantic production and recognition deficits are associated with damage to the left anterior temporal lobe and white matter connectivity with frontal cortex, respectively. These findings provide a novel synthesis of traditional and contemporary views of the cognitive and neural architecture of language processing, emphasizing dual routes for speech processing and convergence of white matter tracts for semantic control and/or integration. Contemporary neuroimaging techniques are enabling precise analysis of structure–function relations in the brain. This study combines large-scale structural neuroimaging and behavioural analyses in patients with acquired aphasia to elucidate the neural organization of spoken language processing.

Post-stroke aphasia might improve over many years with speech and language therapy; however speech and language therapy is often less readily available beyond a few months after stroke. We assessed self-managed computerised speech and language therapy (CSLT) as a means of providing more therapy than patients can access through usual care alone. In this pragmatic, superiority, three-arm, individually randomised, single-blind, parallel group trial, patients were recruited from 21 speech and language therapy departments in the UK. Participants were aged 18 years or older and had been diagnosed with aphasia post-stroke at least 4 months before randomisation; they were excluded if they had another premorbid speech and language disorder caused by a neurological deficit other than stroke, required treatment in a language other than English, or if they were currently using computer-based word-finding speech therapy. Participants were randomly assigned (1:1:1) to either 6 months of usual care (usual care group), daily self-managed CSLT plus usual care (CSLT group), or attention control plus usual care (attention control group) with the use of computer-generated stratified blocked randomisation (randomly ordered blocks of sizes three and six, stratified by site and severity of word finding at baseline based on CAT Naming Objects test scores). Only the outcome assessors and trial statistician were masked to the treatment allocation. The speech and language therapists who were doing the outcome assessments were different from those informing participants about which group they were assigned to and from those delivering all interventions. The statistician responsible for generating the randomisation schedule was separate from those doing the analysis. Co-primary outcomes were the change in ability to retrieve personally relevant words in a picture naming test (with 10% mean difference in change considered a priori as clinically meaningful) and the change in functional communication ability measured by masked ratings of video-recorded conversations, with the use of Therapy Outcome Measures (TOMs), between baseline and 6 months after randomisation (with a standardised mean difference in change of 0·45 considered a priori as clinically meaningful). Primary analysis was based on the modified intention-to-treat (mITT) population, which included randomly assigned patients who gave informed consent and excluded those without 6-month outcome measures. Safety analysis included all participants. This trial has been completed and was registered with the ISRCTN, number ISRCTN68798818. From Oct 20, 2014, to Aug 18, 2016, 818 patients were assessed for eligibility, of which 278 (34%) participants were randomly assigned (101 [36%] to the usual care group; 97 [35%] to the CSLT group; 80 [29%] to the attention control group). 86 patients in the usual care group, 83 in the CSLT group, and 71 in the attention control group contributed to the mITT. Mean word finding improvements were 1·1% (SD 11·2) in the usual care group, 16·4% (15·3) in the CSLT group, and 2·4% (8·8) in the attention control group. Word finding improvement was 16·2% (95% CI 12·7 to 19·6; p<0·0001) higher in the CSLT group than in the usual care group and was 14·4% (10·8 to 18·1) higher than in the attention control group. Mean changes in TOMs were 0·05 (SD 0·59) in the usual care group (n=84), 0·04 (0·58) in the CSLT group (n=81), and 0·10 (0·61) in the attention control group (n=68); the mean difference in change between the CSLT and usual care groups was –0·03 (–0·21 to 0·14; p=0·709) and between the CSLT and attention control groups was –0·01 (–0·20 to 0·18). The incidence of serious adverse events per year were rare with 0·23 events in the usual care group, 0·11 in the CSLT group, and 0·16 in the attention control group. 40 (89%) of 45 serious adverse events were unrelated to trial activity and the remaining five (11%) of 45 serious adverse events were classified as unlikely to be related to trial activity. CSLT plus usual care resulted in a clinically significant improvement in personally relevant word finding but did not result in an improvement in conversation. Future studies should explore ways to generalise new vocabulary to conversation for patients with chronic aphasia post-stroke. National Institute for Health Research, Tavistock Trust for Aphasia.

Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam–Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

The cerebellum has emerged as a potential target for transcranial direct current stimulation (tDCS) in post-stroke aphasia (PSA) due to its role in language processing and relative preservation compared to supratentorial lesions. Recent evidence also highlights the cerebellum’s involvement in affective and social processes, suggesting potential broader effects of cerebellar modulation. This study investigated the efficacy of anodal tDCS over the right cerebellum paired with speech and language therapy in enhancing language functions and quality of life in individuals with PSA. Twenty-two participants with chronic PSA received cerebellar tDCS, while historical sham control data from 25 participants were obtained. Language outcomes were assessed using the Western Aphasia Battery-Revised (WAB-R), and secondary outcomes included patient-reported measures of communication effectiveness and quality of life. Mixed-design analyses of variance were conducted to examine treatment effects. No significant Group x Time interaction was found for WAB-R scores, indicating that tDCS did not provide additional language benefits over speech therapy. However, a significant Group x Time interaction was observed for the Stroke and Aphasia Quality of Life Scale-39 scores, driven by improvements in the Psychosocial, Physical, and Energy subdomains in the tDCS group. Cerebellar tDCS did not significantly improve language outcomes in PSA individuals but enhanced specific aspects of quality of life. These findings highlight the cerebellum’s multifaceted role in cognitive, affective, and sensorimotor processes. Future research should focus on conducting well-powered, randomized, double-blind, and concurrent trials to validate these findings and explore optimal stimulation parameters in PSA rehabilitation. Trial registration : The trial is registered at ClinicalTrials.gov with the registration number NCT03699930. The date of registration is 10/05/2018.

Group-based singing has been shown to improve language outcomes and induce structural neuroplasticity in chronic post-stroke aphasia (PSA). However, the functional neuroplasticity changes induced by such interventions remain unknown. Here our main aim was to determine these changes using a cross-over randomised trial. Nineteen patients with PSA were randomly allocated to a 4-month multicomponent singing-based intervention (singing group) or standard care (control group). With a pre-post design, we pooled data from both groups and analysed verbal learning and task-based fMRI activation of two novel songs (trained or untrained during intervention) at two time points (pre- and post-intervention). Post-intervention, patients with PSA produced more correct syllables from the trained song and for the trained relative to the untrained song. fMRI results revealed increased activation when singing along to the trained song in the right postcentral gyrus, and in the right posterior superior temporal gyrus (pSTG) when singing along to the trained vs. untrained song. Notably, right pSTG activation increases correlated with improved naming abilities. Collectively, these findings indicate that group-based singing is associated with verbal learning and induces functional neuroplasticity changes in the singing network, derived from demographically matched healthy controls, which are associated to improved naming abilities in chronic PSA. https://www.clinicaltrials.gov , Unique identifier: NCT03501797.

AbstractObjectiveTo evaluate whether right neurotomy of the seventh cervical nerve (C7) at the intervertebral foramen plus intensive speech and language therapy (SLT) improves language function compared intensive SLT alone in patients with chronic aphasia after stroke.DesignMulticentre, assessor blinded, randomised controlled trial.SettingFour centres in mainland China.Participants50 adults aged 40-65 years with aphasia for more than one year after a single left hemispheric stroke.InterventionsParticipants were randomised 1:1 to receive either C7 neurotomy plus three weeks of intensive SLT or three weeks of intensive SLT only, stratified by treatment centre.Main outcome measuresThe primary outcome was change in score on the 60 item Boston naming test (BNT, scores 0-60, with higher scores indicating better naming function) from baseline to one week after C7 neurotomy plus intensive SLT for three weeks or intensive SLT for three weeks after deferral for one week (control group). Secondary outcomes included change in severity of aphasia using the aphasia quotient, calculated using the western aphasia battery, and patient reported outcomes on quality of life and depression after stroke.ResultsFrom 25 July 2022 to 31 July 2023, 322 out of 1086 patients received a diagnosis of post-stroke aphasia and were screened for eligibility. 50 eligible participants were randomly assigned to treatment groups (25 in each). Mean increase in BNT score was 11.16 points in the neurotomy plus SLT group and 2.72 points in the control group at one month (difference 8.51 points, 95% confidence interval (CI) 5.31 to 11.71, P<0.001). The between group difference in BNT score remained stable at six months (difference 8.26 points, 4.16 to 12.35, P<0.001). In addition, the aphasia quotient improved significantly in the neurotomy plus SLT group versus control group (difference at one month 7.06 points, 4.41 to 9.72, P<0.001), as did patient reported activities of daily living and post-stroke depression. No treatment related severe adverse events were reported.ConclusionsC7 neurotomy plus three weeks of intensive SLT was associated with a greater improvement in language function compared with three weeks of intensive SLT alone over a period of six months. No severe adverse events or long term troublesome symptoms or functional loss were reported.Trial registrationChinese Clinical Trial Register ChiCTR2200057180.

BackgroundLanguage impairment (aphasia) is a common neurological deficit after strokes. For individuals with chronic aphasia (beyond 6 months after the stroke), language improvements with speech therapy (ST) are often limited. Transcranial direct current stimulation (tDCS) is a promising approach to complement language recovery but interindividual variability in treatment response is common after tDCS, suggesting a possible relationship between tDCS and type of linguistic impairment (aphasia type).MethodsThis current study is a subgroup analysis of a randomised controlled phase II futility design clinical trial on tDCS in chronic post-stroke aphasia. All participants received ST coupled with tDCS (n=31) vs sham tDCS (n=39). Confrontation naming was tested at baseline, and 1, 4, and 24 weeks post-treatment.ResultsBroca’s aphasia was associated with maximal adjunctive benefit of tDCS, with an average improvement of 10 additional named items with tDCS+ST compared with ST alone at 4 weeks post-treatment. In comparison, tDCS was not associated with significant benefits for other aphasia types F(1)=4.23, p=0.04. Among participants with Broca’s aphasia, preservation of the perilesional posterior inferior temporal cortex was associated with higher treatment benefit (R=0.35, p=0.03).ConclusionsThese results indicate that adjuvant tDCS can enhance ST to treat naming in Broca’s aphasia, and this may guide intervention approaches in future studies.

Aphasia, a communication disorder caused primarily by left-hemisphere stroke, affects millions of individuals worldwide, with up to 70% experiencing significant reading impairments. These deficits negatively impact independence and quality of life, highlighting the need for effective treatments that target the cognitive and neural processes essential to reading recovery. This Randomized Clinical Trial (RCT) aims to test the efficacy of a combined intervention incorporating aerobic exercise training (AET) and phono-motor treatment (PMT) to enhance reading recovery in individuals with post-stroke aphasia. AET, known for its positive impact on cerebral blood flow (CBF) and oxygenation, is hypothesized to facilitate neuroplasticity when administered before PMT, an intensive therapy aimed at strengthening phonological processing. While most existing treatments focus on spoken language production, this study builds on evidence that PMT can also improve reading skills. The study is structured as a Phase I/II clinical trial and compares the effects of AET plus PMT to a control condition of stretching plus PMT on reading and other language outcomes including naming, auditory comprehension, and spontaneous speech. Additionally, it investigates the immediate and sustained impacts of the intervention on CBF, functional connectivity, and task-evoked brain activity. The central hypothesis posits that AET will increase CBF and, when combined with PMT, will lead to enhanced reading recovery, supporting treatment-induced plasticity. This trial represents one of the first large-scale interventions targeting post-stroke reading impairments and provides critical insights into the potential of combining AET with cognitive rehabilitation to improve language recovery in aphasia.

Oral reading for language in aphasia (ORLA) therapy coupled with telerehabilitation (TR) is a promising adjunct to treatment for aphasia. This single-center, randomized, single-blind, 6-month trial aimed to evaluate whether ORLA combined with TR demonstrates comparable efficacy to conventional ORLA offline rehabilitation for improving comprehensive language ability in subacute aphasia patients while assessing longitudinal treatment effects. Enrolled patients were randomized 1:1:1 into Group A (medium–high intensity ORLA TR), Group B (low-intensity ORLA TR), and Group C (medium–high intensity ORLA offline). All groups received a 6-month, 90-h intervention comprising three treatment phases. The primary outcome was a change in Aphasia Quotient (AQ) at baseline and 4 weeks, 3 months, and 6 months post-treatment. The secondary outcomes included quality of life and language subscale scores at the same time points. A total of 42 participants were analyzed, Group A demonstrated a non-significant mean difference of − 0.62 (95% CI − 5.00 to 6.23; P  = 0.825) in AQ compared to Group C. A statistically significant difference in the Stroke Aphasia Quality of Life-39 Scale (SAQOL-39) scores between Group A and Group C (mean difference: − 8.19; 95% CI [− 12.39, − 3.99]; P  < 0.001). Group A vs. Group C: No statistically significant differences were observed in any of the aforementioned language subskills between Group A and Group C ( P  > 0.05 for all comparisons). ORLA combined with TR demonstrated comparable efficacy to conventional ORLA offline rehabilitation, serving as a viable alternative for home-based speech rehabilitation in subacute aphasia patients. This TR approach improved both comprehensive language ability and quality of life, with sustained treatment effects over time. First registration date: August 18, 2023 (retrospective registration, Chinese Clinical Trial Registry number: ChiCTR2300074870).

Speech and language therapy provision for aphasia (a language disorder) post stroke has been studied over time through surveys completed by speech and language therapists. This paper revisits provision based on what was received by 278 patients in 21 UK speech and language therapy departments in 2014-2016. To explore the speech and language therapy received by community dwelling people with post stroke aphasia in the UK. A quantitative content analysis was conducted by two speech and language therapist researchers. Therapy goals recorded were coded into categories and subcategories. Descriptive statistics were used to identify the frequency with which goal categories were targeted, average therapy time received, length and frequency of therapy sessions, personnel involved and mode of delivery. Forty-five percent of participants were in receipt of therapy in the three month window observed. Six goal categories were identified. Rehabilitation was the most frequent (60%) followed by enabling (17.2%), review (4.3%), assessment (3.6%), supportive (3.5%) and activity to support therapy (2.8%). The median amount of therapy received in three months was 6.3 hours at an average of one 60-minute session every two weeks. Seventy-seven percent of therapy sessions were delivered by qualified speech and language therapists and 23% by assistants. Ninety percent of sessions were one to one, face to face sessions whilst 9.5% were group sessions. In line with previous reports, speech and language therapy for community dwelling stroke survivors with aphasia is restricted. Rehabilitation is a large focus of therapy but the intensity and dose with which it is provided is substantially lower than that required for an effective outcome. Despite this, one to one face to face therapy is favoured. More efficient methods to support more therapeutic doses of therapy are not commonly used in routine clinical services.