Aphasia Neuroplasticity Review

Griffis et al. (2016)

Reference

AuthorsGriffis JC, Nenert R, Allendorfer JB, Szaflarski JP
TitleInterhemispheric plasticity following intermittent theta burst stimulation in chronic poststroke aphasia
ReferenceNeural Plast 2016; 2016: 4796906
PMID26881111
DOI10.1155/2016/4796906

Participants

LanguageUS English
Inclusion criteriaModerate aphasia, L MCA
Number of individuals with aphasia8 (plus 3 excluded: 2 metallic artifact; 1 seizure at time of stroke)
Number of control participants0
Were any of the participants included in any previous studies?Yes (same patients as Szaflarski et al. (2011); different fMRI paradigm acquired in the same sessions)
Is age reported for patients and controls, and matched?Yes (mean 54.4 ± 12.7 years)
Is sex reported for patients and controls, and matched?Yes (males: 4; females: 4)
Is handedness reported for patients and controls, and matched?Yes (right: 8; left: 0)
Is time post stroke onset reported and appropriate to the study design?Yes (mean 5.3 ± 3.6 years)
To what extent is the nature of aphasia characterized?Severity and type
Language evaluationBNT; phonemic fluency, semantic fluency, complex ideation from BDAE, PPVT, communicative activities log
Aphasia severityModerate
Aphasia type4 Broca's, 3 anomic, 1 anomic/conduction
First stroke only?Not stated
Stroke typeNot stated
To what extent is the lesion distribution characterized?Individual lesions
Lesion extentRange 1.4-52.5 cc
Lesion locationL MCA
Participants notes

Imaging

ModalityfMRI
Is the study cross-sectional or longitudinal?Longitudinal—chronic treatment
If longitudinal, at what time point(s) were imaging data acquired?T1: pre-treatment/chronic; T2: post-treatment, ~2 weeks later
If longitudinal, was there any intervention between the time points?RTMS to residual activation near Broca's area, 5 sessions/week, 2 weeks
Is the scanner described?Yes (Varian Unity INOVA 4 Tesla)
Is the timing of stimulus presentation and image acquisition clearly described and appropriate?Yes
Design typeBlock
Total images acquired140
Are the imaging acquisition parameters, including coverage, adequately described and appropriate?Yes (whole brain)
Is preprocessing and intrasubject coregistration adequately described and appropriate?Yes
Is first level model fitting adequately described and appropriate?Yes
Is intersubject normalization adequately described and appropriate?No (lesion impact not addressed)
Imaging notes

Conditions

Are the conditions clearly described?Yes
ConditionResponse typeRepetitionsAll groups could do?All individuals could do?
verb generationMultiple words (covert)7YesYes
finger tappingOther7UnknownUnknown
Conditions notes

Contrasts

Are the contrasts clearly described?Yes

Contrast 1: verb generation vs finger tapping

Language conditionVerb generation
Control conditionFinger tapping
Are the conditions matched for visual demands?Yes
Are the conditions matched for auditory demands?Yes
Are the conditions matched for motor demands?No
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Is reaction time matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Behavioral data notes
Are control data reported in this paper or another that is referenced?Yes
Does the contrast selectively activate plausible relevant language regions in the control group?Yes
Are activations lateralized in the control data?Somewhat
Control activation notesControl data in Szaflarski et al. (2008); frontal activation L-lateralized, temporal less so
Contrast notes

Analyses

Are the analyses clearly described?No (see specific limitation(s) below)

Voxelwise analysis 1

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal change in aphasia
Group(s)Aphasia T2 vs T1
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisVoxelwise
Search volumeWhole brain
Correction for multiple comparisonsNo correction
SoftwareSPM12
Voxelwise p.001
Cluster extentNone
Statistical details
Findings↑ L IFG pars opercularis
↑ R cerebellum
↑ R thalamus
↓ R anterior temporal
↓ R cerebellum
Findings notesBased on description in text; it is noted that no regions survived FDR correction

ROI analysis 1

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal change in aphasia
Group(s)Aphasia T2 vs T1
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeMixed
How many ROIs are there?3
What are the ROI(s)?(1) L IFG; (2) R IFG; (3) frontal LI
How are the ROI(s) defined?First principal component of 8 mm spheres defined based on previously reported control peaks
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsLesion volume included in model
Findings↑ L IFG
↓ R IFG
↑ LI (frontal)
Findings notes

ROI analysis 2

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal correlation with language or other measure
Group(s)Aphasia T2 vs T1
CovariateΔ semantic fluency
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeMixed
How many ROIs are there?3
What are the ROI(s)?(1) L IFG; (2) R IFG; (3) frontal LI
How are the ROI(s) defined?First principal component of 8 mm spheres defined based on previously reported control peaks
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsLesion volume included in model
Findings↓ R IFG
Findings notesDecreased R IFG activation was correlated with improved semantic fluency

Complex analysis 1

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal change in aphasia
Group(s)Aphasia T2 vs T1
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisComplex
Statistical detailsPPI analyses were used to investigate change over time in modulation by verb generation of functional connectivity between L IFG and R IFG.
FindingsOther
Findings notesThere was a significant decrease in modulation by verb generation of functional connectivity between L IFG and R IFG (p = 0.03). Prior to TMS, connectivity increased during verb generation compared to finger tapping, while after TMS, connectivity decreased during verb generation compared to finger tapping.

Complex analysis 2

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal correlation with language or other measure
Group(s)Aphasia T2 vs T1
CovariateΔ semantic fluency in association with modulation of interhemispheric IFG connectivity by verb generation
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisComplex
Statistical detailsPPI analyses were used to investigate whether change over time in modulation by verb generation of functional connectivity between L IFG and R IFG was associated with changes in semantic fluency scores, which are limited as a measure of language improvement.
FindingsNone
Findings notes

Complex analysis 3

First level contrastVerb generation vs finger tapping
Analysis classLongitudinal change in aphasia
Group(s)Aphasia T2 vs T1
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (patients improved only on semantic fluency)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisComplex
Statistical detailsPPI analyses were used to investigate change over time in modulation by verb generation of functional connectivity between R IFG and all other brain regions. Voxelwise p < .001, not corrected for multiple comparisons.
FindingsOther
Findings notesReduced connectivity was observed in the L IFG pars opercularis, L anterior temporal lobe, L occipital lobe, L basal ganglia, R SMA and pre-SMA, R somato-motor cortex, R posterior MTG, and R cerebellum. It is noted that no regions survived FDR correction.

Notes

Excluded analyses(1) correlations between lesion volume and functional measures, not described in sufficient detail; (2) ad hoc analyses in section 3.4