None listed
Conditions
Brief summary
Background: This NHMRC funded project (2016-2019) will address the fundamental lack of knowledge regarding the brain structure and function responsible for aphasia recovery and determine the best predictors of language improvement and treatment response in the sub-acute phase of brain recovery. Aims & Method: The specific aims of this research are to (1) Identify changes in brain activity from sub-acute to chronic phases in response to naming treatment versus usual care (2) Determine whether subacute brain activity predicts subsequent language recovery and successful treatment (3) Determine structural predictors of language recovery and treatment response (4) Develop a machine learning algorithm that accurately identifies individual patients who will recover language and make significant improvements. 90 participants with post-stroke aphasia will be scanned (at Herston Imaging Research Facility, RBWH campus) and tested on a battery of language tests at the sub-acute stage (1 month post-onset), then assigned to 8 weeks (3 times per week) naming and language treatment versus usual care and then scanned and retested at 3 and 6 months post-onset. 25 healthy older control participants will also be recruited and scanned. Outcomes: Using state-of-the art imaging techniques together with clinically meaningful markers of language function, this research will test for the first time whether brain structure and function in sub-acute stroke can reliably predict the recovery of specific language functions and treatment response.
Interventions
The patient cohort will be randomly assigned to either treatment or a usual care control condition (stratified based on severity of language deficit).
Prior to receiving treatment or usual care, all participants will undertake a neuroimaging scan, including a language-based functional MRI, which will be used as a predictor for language recovery.
Therapy group:
- The therapy provided to participants in the therapy group of the study will include individual word retrieval treatment focused prima
The patient cohort will be randomly assigned to either treatment or a usual care control condition (stratified based on severity of language deficit). Prior to receiving treatment or usual care, all participants will undertake a neuroimaging scan, including a language-based functional MRI, which will be used as a predictor for language recovery. Therapy group: - The therapy provided to participants in the therapy group of the study will include individual word retrieval treatment focused primarily on the phonological (sound) representation - The word retrieval treatment will be delivered individually at 1 month post-stroke onset (following scanning) by qualified speech pathologists over 3 x 1 hour sessions a week for a period of 8 weeks. - Stimuli (nouns) will be selected for treatment based on pre-test performance indicating difficulties with naming individual items. 2 sets of items will be selected (matched for relevant psycholinguistic variables), with one set treated and the other untreated to test for generalisation. - The content of treatment is based on evidence for the effectiveness of word retrieval treatments that include repetition, phonological cueing, and phonological judgments (e.g., Nickels, 2000; Van Hees et al., 2013). In accordance with Leonard et al. (2008) and our work (Van Hees et al., 2013), patients are asked to attempt to name the item. They are then asked to produce the features of the item according to each cue word in a matrix. The cues include: first sound, syllables, last sound, association, and rhyme. If a participant is unable to produce a response, the clinician provides a response both orally and in written form. After all the features are produced, the participant is asked to name the item again. Another component of treatment will involve repetition of the name in the presence of its picture. - Treatment will also include computer-based therapy (guided by the clinician, approximately 20% of each session), including picture naming for word retrieval, reading aloud for reading comprehension and script practice. Additional activities focused on phrase-level production may be included if impairments are identified (Rodriguez et al., 2013). Homework tasks may also be provided as part of the individualised treatment. - Patients may receive usual care for other speech and communication impairments. - Intervention adherence/fidelity will be assessed by recording a sample from a treatment session that will then be reviewed by one of the principal investigators. Strategies used to maintain/improve fidelity will include meetings with research therapists to discuss therapy provision.
Sponsors
Professor David Copland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
People with aphasia: - Single, first, left hemisphere stroke (as confirmed by CT/MRI) and speech and language impairment as identified by a speech pathologist or other relevant medical, nursing or allied health staff -Below the aphasia cut-off (93.8 AQ) on the Western Aphasia Battery - Revised (WAB-R) or asphasia (including high level language deficits) as identified by a speech pathologist or other relevant medical, nursing or allied health staff - MRI compatibility, and able to complete behavioural battery between 2 and 6 weeks post-stroke - Have sufficient vision and hearing to complete the imaging and behavioural tasks - Medically stable and able to attend and participate in a therapy program (8 weeks) - English as a primary language prior to stroke Control Group: - healthy older adults matched for age and gender.
Exclusion criteria
People with aphasia: - Any other neurological disease or disorder, mental illness, head trauma, alcoholism, cerebral tumour or abscess. - Any metals present in the body or other contraindications for MRI including claustrophobia. - Current diagnosis of major clinical depression or other mental health condition that may affect participation. - Severe dysarthria or apraxia of speech as determined by a speech pathologist. - Severe auditory comprehension deficits as determined by the WAB-R which would preclude following directions for the scan. - Substance abuse or dependence in the last 12 months. Healthy controls: - Any brain/neurological disorder, mental illness, head trauma, alcoholism and cerebral tumour - Any contraindications for MRI – claustrophobia or metals in the body e.g., pacemaker, heart valve, dental bridge metal mesh implants/clips/wire sutures, hearing implant etc.
Outcome results
None listed