1. Compensatory Reorganization in Recovery from Aphasia after Stroke Bruce Crosson, Ph.D. Brain Rehabilitation Research Center Malcom Randall VA Medical Center and Department of Clinical & Health Psychology University of Florida Gainesville, Florida Only published work or work presented at meetings is included in these slides.

2. Collaborators Rehabilitation Rehabilitation Leslie Gonzalez Rothi, Ph.D. Katherine S. Richards, M.S. Christina E. Wierenga, M.S. M. Allison Cato, Ph.D. Flo Singletary, M.A. Maribel Ciampiti, M.A. Beth Holliway, M.A. Amy Rodriguez, M.A. Susan Leon, M.A. Cynthia Beaulieu, Ph.D. R. Bruce Parkinson, M.S. Megan E. Gaiefsky, M.S. Anastasia M. Raymer, Ph.D. Lynn M. Maher, Ph.D. Tim W. Conway, Ph.D. NeuroImaging NeuroImaging Richard W. Briggs, Ph.D. Keith D. White, Ph.D. Anna Bacon Moore, Ph.D. Megan Gaiefsky, M.S. Kaundinya Gopinath, Ph.D. Tim W. Conway, Ph.D. K. K. Peck, Ph.D. David Soltysik, Ph.D. Christina Milsted Michelle Benjamin, M.S. Keith McGregor R. Bruce Parkinson, M.S. Ashley Wabnitz Trista Perez Yu-ling Chang, M.S. Ashley Orynich

3. Funding Sources NIDCD #P50 DC03888 Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson and Richard Briggs Imaging Core PIs VA RR&D #F2182C Leslie J. Gonzalez Rothi, Center Director; Bruce Crosson Imaging Core Coordinator VA RR&D #B3470S Bruce Crosson, PI (Research Career Scientist) VA RR&D #C2602V Anna Moore, PI (Research Career Development Award) VA RR&D ##B3480H Tim W. Conway, PI (Associate Investigator Award)

4. 1.RECOVERY: Does reorganization of function occur primarily in perilesional cortex of the dominant hemisphere (left) or in the previously nondominant (right) hemisphere? 2.REHAB: Does rehabilitation influence the hemisphere to which language reorganizes? Reorganization of Language in Aphasia: Left or Right Hemisphere? Review from: Crosson, B. (in press). Functional neuroimaging of impaired language: Aphasia. In Hillary & DeLuca (eds.) Functional Neuroimaging in Clinical Populations. New York: Guilford.

5. Good Recovery: small lesions, greater perilesional than right- hemisphere reorganization Poor Recovery: large lesions, greater right-hemisphere than perilesional reorganization References: Cao et al., 1999; Heiss et al., 1997, 1999; Karbe et al., 1998; Perani et al., 2003; Rosen et al., 2000 RECOVERY REVIEW Conclusion #1

6. F15 M10 M62 M31 L R L R L R L R Sentence Generation: 4 Patients with Syntactic Impairments McGregor et al., POSTER: 11 – 12:30 Saturday

7. Shifts to right-hemisphere homologues of damaged left-hemisphere areas References: Blank et al., 2003; Calvert et al., 2000; Lazar et al., 2000; Thulborn, 1999; Weiller et al., 1995). RECOVERY REVIEW Conclusion #2

8. Role of Intention / Attention Mechanisms in Reorganization Anterior lesion with intact basal ganglia: Reorganization of language production to the right frontal lobe Anterior + basal ganglia lesion: Bilateral frontal activity during language production Reference: (Kim et al., 2002). RECOVERY REVIEW Conclusion #3

9. Caudate Putamen Thalamus L L S01 S02 Lesions: S01 and S02 Crosson et al. (2005) Journal of Cognitive Neuroscience

10. Activity Volume (microliters) Activity (fMRI Task: Event-Related Word Generation) (Using Selective Detrending) Crosson et al. (2005) Journal of Cognitive Neuroscience S01: Basal Ganglia Lesion S02: No Basal Ganglia Lesion

11. Treatment outcome affected by lesion size and location REHABILITATION REVIEW Conclusion #1

12. .004.004 -.749 -.749.005.005 -.785 rp Object naming improvement vs. basal ganglia (N=13) Action naming improvement vs. basal ganglia (N=12) Correlations between Naming Improvement and Basal Ganglia Lesion Extent: Partial Correlations Controlling for Anterior Cortical Lesion Extent Parkinson et al., POSTER: 11 – 12:30 Saturday

13. Hypotheses about Basal Ganglia Basal ganglia involved in suppression of behavior / cognition Damaged anterior language production mechanisms produce noisy output, hampering production Intact basal ganglia suppress noisy output

14. rp Anterior lesion vs. object naming improvement (N=13).858 <.0005 Anterior lesion vs. action naming improvement (N=12).821.002 Correlations between Naming Improvement and Cortical Lesion Extent: Partial Correlation Controlling for Basal Ganglia Lesion Extent Parkinson et al., POSTER: 11 – 12:30 Saturday

15. Small Lesion Perilesional Reorganization Optimal: L Hemisphere Best Substrate Perilesional Activity “Noisy” Competes with R Hemisphere Perilesional Activity Impossible: R Hemisphere Best Substrate Critical Cortex Lesion Size and Perilesional Activity Chronic Aphasia Cases Large Lesion

16. It may be possible to influence the hemisphere in which language functions are performed through treatment REHABILITATION REVIEW Conclusion #2

17. Before Training After Training RIGHT LEFT RIGHT LEFT 00-008: Pre- and Post-Tx Images Frontal Activity Crosson et al. (2005) Journal of Cognitive Neuroscience

18. “Activity” during fMRI does not signify contribution to language It might even be detrimental References: Martin et al., 2004; Naeser et al., 2005; Rosen et al., 2000 REHABILITATION REVIEW Conclusion #3

19. Activity in right-hemisphere homologues of damaged left- hemisphere language cortex can be critical for rehabilitation Reference: Musso et al., 1999 REHABILITATION REVIEW Conclusion #4

20. Reactivating intact left-hemisphere language cortex can also be critical in rehabilitation REHABILITATION REVIEW Conclusion #5

21. G01 Pre-Treatment J02 Pre-Treatment G01 Post-Treatment J02 Post-Treatment Lateral Medial X = -52 X = -40 X = -45 X = -36 X = -56 X = -47 X = -54 X = -48 Lateral Medial Lateral Medial Lateral Medial G01 Outcome: Improved word order in sentences with generalization to narrative sample J02 Outcome: Improved word order in sentences with no generalization to narrative sample Syntactic Mapping Treatment (fMRI Task: Active Sentence Generation from Picture) Wierenga et al. (in press) Journal of the International Neuropsychological Society

22. PRE POST RightAuditory BA 42 LeftAuditoryBA42 Chang et al., POSTER: 9 – 10:30 Friday Phonological Rehabilitation (Nonsense Syllable Repetition)

23. Take Home Messages 1.Both the left and right hemispheres participate in recovery from and rehabilitation for aphasia. The degree of right vs. left participation depends on the patient, the size of the lesion, the location of the lesion, and the language function in question. 2.It may be possible to manipulate intentional mechanisms to change the hemisphere from which language production is performed if that is desirable. 3.Activity in a structure (in the left or right hemisphere) during functional neuroimaging tasks does not mean it is making a positive contribution to performance.

24. Posters, bibliography, and slides of completed work at www.BIRC.phhp.ufl.edu