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Cognitive neurology
Review
Neuroplasticity and aphasia treatments: new approaches for an old problem
Free
  1. Bruce Crosson1,2,
  2. Amy D Rodriguez1,2,
  3. David Copland3,4,
  4. Julius Fridriksson5,
  5. Lisa C Krishnamurthy1,6,
  6. Marcus Meinzer7,
  7. Anastasia M Raymer8,
  8. Venkatagiri Krishnamurthy1,2,
  9. Alexander P Leff9
  1. 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia, USA
  2. 2 Department of Neurology, Emory University, Atlanta, Georgia, USA
  3. 3 School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  4. 4 Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
  5. 5 Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
  6. 6 Department of Physics and Astronomy, Georgia State University, Atlanta, Georgia, USA
  7. 7 Department of Neurology, University of Greifswald, Greifswald, Germany
  8. 8 Department of Communication Disorders and Special Education, Old Dominion University, Norfolk, Virginia, USA
  9. 9 Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr Bruce Crosson, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA 30033, USA; bruce.crosson{at}emory.edu

Abstract

Given the profound impact of language impairment after stroke (aphasia), neuroplasticity research is garnering considerable attention as means for eventually improving aphasia treatments and how they are delivered. Functional and structural neuroimaging studies indicate that aphasia treatments can recruit both residual and new neural mechanisms to improve language function and that neuroimaging modalities may hold promise in predicting treatment outcome. In relatively small clinical trials, both non-invasive brain stimulation and behavioural manipulations targeting activation or suppression of specific cortices can improve aphasia treatment outcomes. Recent language interventions that employ principles consistent with inducing neuroplasticity also are showing improved performance for both trained and novel items and contexts. While knowledge is rapidly accumulating, larger trials emphasising how to select optimal paradigms for individualised aphasia treatment are needed. Finally, a model of how to incorporate the growing knowledge into clinical practice could help to focus future research.

  • aphasia
  • brain mapping
  • functional imaging
  • rehabilitation
  • stroke

https://doi.org/10.1136/jnnp-2018-319649

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    Footnotes

    • Contributors BC and ADR developed the manuscript concept and structure. APL developed the vision for use of neuroimaging in future treatment planning in one of the figures and its caption . BC and ADR edited the final manuscript. Otherwise, all authors contributed equally to the literature review and preparation of the manuscript, as well as to the preparation/selection of figures.

    • Funding BC received funding from the Veterans Affairs Rehabilitation Research & Development Service (USA) grant B6364-L; DAC received funding from National Health and Medical Research Council (Australia) Grant APP1104194 and University of Queensland Vice Chancellor’s Fellowship; JF received funds from the National Institutes of Health/National Institute on Deafness and Other Communication Disorders (USA) grant P50 DC014664; APL received funds from a National Institute for Health Research (UK) Research Professorship RP-2015-06-012; MM received funding from Australian Research Council Future Fellowship FT120100608 and National Health and Medical Research Council (Australia) Grant Number 1085272; AR received funding from the Veterans Affairs Rehabilitation Research & Development Service (USA) grant C2238-P. LCK received funding from the Veterans Affairs Rehabilitation Research & Development Service (USA) grant IK1 RX002629. The views presented in this work do not necessarily represent the views of the United States Government or the Department of Veterans Affairs.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.