Ischemic or Hemorrhagic Stroke
Conditions
Keywords
brain connectivity, aphasia, art therapy, rehabilitation
Brief summary
A stroke located in the left parieto-temporal junction is associated, in aphasic right-handed patients, with a poor prognosis for language recovery. The role of the right hemisphere in recovering post-stroke aphasia is still controversial. Our hypothesis, based on recent work in imaging, is that early activation of the right hemisphere linked to the practice of the visual arts could facilitate language recovery in extended posterior left strokes that completely disrupt language areas.
Detailed description
The investigators will evaluate, at inclusion and at 6 weeks, the reorganization of functional and structural brain connectivity maps before and after rehabilitation of aphasia with art therapy and standard orthophonic rehabilitation versus a control group that received only standard orthophonic rehabilitation. The investigators will include all consecutive patients with recent ischemic or hemorrhagic stroke with unilateral lesion(s) of the parieto-temporal left junction present on the Diffusion MRI (DWI) performed in acute phase at 24-48h. All patients will undergo 2 MRI with tensor diffusion sequences (structural connectivity) and fMRI (functional magnetic resonance imaging) resting state sequences (functional connectivity) at inclusion and 6 weeks after rehabilitation with or without art therapy. The investigators aimed to demonstrate that early activation of the right hemisphere related to the practice of the visual arts could facilitate the recovery of language in later strokes completely disrupting the language areas of the left hemisphere.
Interventions
OTHERArt therapy and standard orthophonic rehabilitation
In addition to standard orthophonic rehabilitation, the patient will receive 12 sessions of art therapy
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Single-blind: only the art therapist knows the randomization arm. The investigators involved in the outcomes assessement, will remain blinded with regard to the randomized treatment assignments
Intervention model description
The investigators will evaluate the reorganization of functional and structural brain connectivity maps before and after rehabilitation of aphasia with art therapy and standard orthophonic rehabilitation versus a control group that received only standard orthophonic rehabilitation.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with recent ischemic or haemorrhagic stroke with unilateral lesion (s) of the parieto-temporal left junction present on the Diffusion MRI (DWI) performed in acute phase at 24-48h * Post stroke delay of 15 days to 2 months * Existence of moderate to severe phasic disorders on Aphasia Rapid Test score (ART, score\> 6, scale of 26 items) * Patient able to read and understand French * Rightful * Normal and corrected vision and hearing * Absence of pre-existing degenerative neurological disorder * Patient having signed his consent * Age ≥ 18 years
Exclusion criteria
* Patients with contraindications to MRI or claustrophobic * Patients under legal protection * Patients with behavioral disorders or disabling neurovisual disorders making participation in art therapy impossible * Mute patients, illiterate patients * Patients leaving the neurological SSR department prematurely * Patients not affiliated to a social security scheme * Pregnant or lactating women.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| change from baseline measurement of white substance bundles volumes for structural connectivity at 6 weeks | from inclusion at 6 weeks |
| change from baseline measurement of synchrony amplitude of slow fluctuations for functional Connectivity at 6 weeks | from inclusion at 6 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change from baseline Aphasia at 6 weeks | from inclusion at 6 weeks | The BDAE (Boston Diagnostic Aphasia Examination) score ranges from 0 to 5, with higher values indicating more severe impairment |
| change from baseline Anxiety and depression at 6 weeks | from inclusion and at 6 weeks | The HADS (Hospital Anxiety and Depression Scale) scores ranges from 0 to 21 for both anxiety and depression scores, with higher values indicating more severe impairment |
| change from baseline Quality of life self-assessment at 6 weeks | from inclusion at 6 weeks | Visual Analogic scale of patient quality of life is a 0% to 100% scale, with 100 indicating the best health status |
| Satisfaction self-assessment at 6 weeks | at 6 weeks only | visual analogic scale of patient satisfaction is a 0 to 10 scale, with higher values indicating better satisfaction |
Countries
France
Contacts
PRINCIPAL_INVESTIGATORSophie Dupont
Assistance Publique - Hôpitaux de Paris
Outcome results
None listed