Brain Activity Increases in Chronic Stroke Aphasia Patients after Reading and Exercise Treatment
Poster No:
813
Submission Type:
Abstract Submission
Authors:
Melissa Rosahl1, Olga Boukrina1, Brian Sandroff1, Elizabeth Madden2, William Graves3
Institutions:
1Kessler Foundation, West Orange, NJ, 2Florida State University, Tallahassee, FL, 3Rutgers, The State University of New Jersey, Newark, NJ
First Author:
Co-Author(s):
Introduction:
Approximately one third of stroke survivors acquire aphasia, a communication disorder that can significantly impact production and comprehension of spoken language, as well as reading and writing (Flowers et al., 2016). Aphasia can result from stroke-induced damage to dorsal and ventral networks of the brain, leading to reduced activation in left-hemisphere language areas (Willson & Shneck, 2021; Thiel & Zumbansen, 2016). Many stroke survivors with aphasia report reading and writing deficits; furthermore, they highly value their literacy skills and are motivated to improve them (Madden & Bush, 2024).
Prior research shows that aerobic exercise training (AET) generates neuroplasticity at the molecular, functional, and behavioral levels, and offers cognitive benefits in stroke survivors (El Sayes et al., 2016; Mayer et al., 2021). This study tested the effects of a modified version of an aphasia language therapy, phono-motor treatment (PMT), designed to better target reading outcomes and strengthen phonological reading networks (Boukrina et al., 2024), in combination with AET on reading outcomes and brain activity.
In line with prior findings on exercise training in stroke (Robertson et al., 2021), we hypothesized that combining exercise with our modified PMT would lead to an increase in brain activity in the left occipital, parietal, and frontal lobes, along with a corresponding improvement in reading competence as measured by the WAB-AQ and reading aloud tasks.
Prior research shows that aerobic exercise training (AET) generates neuroplasticity at the molecular, functional, and behavioral levels, and offers cognitive benefits in stroke survivors (El Sayes et al., 2016; Mayer et al., 2021). This study tested the effects of a modified version of an aphasia language therapy, phono-motor treatment (PMT), designed to better target reading outcomes and strengthen phonological reading networks (Boukrina et al., 2024), in combination with AET on reading outcomes and brain activity.
In line with prior findings on exercise training in stroke (Robertson et al., 2021), we hypothesized that combining exercise with our modified PMT would lead to an increase in brain activity in the left occipital, parietal, and frontal lobes, along with a corresponding improvement in reading competence as measured by the WAB-AQ and reading aloud tasks.
Methods:
Four participants with chronic post-stroke aphasia (M age=58.75 ± 10.63, 2 women, 75% White, right-handed) completed 22-60 hours of PMT preceded by 20 minutes of moderate intensity aerobic exercise on an upright cycle ergometer 5x/week. We conducted language and reading assessments before and after the intervention. Participants completed a reading aloud task in and out of the 3T Siemens Skyra MR scanner pre- and post-treatment. Voice responses were recorded with an MR-compatible fiberoptic microphone (FOR-MRI-III, Optoacoustics). Brain activity was recorded using rapid simultaneous multi-slice echo-planar imaging (EPI) (TR=1.5s, TE=30ms, 44 slices, gap = .5mm, 2mm∧3 isotropic voxels).
Group fMRI analysis was completed using FSL (version 6.0), with a cluster threshold of Z >1.96 and a corrected significance of p=0.05, with responses to word and nonword presentation modeled separately from overt speech.
Group fMRI analysis was completed using FSL (version 6.0), with a cluster threshold of Z >1.96 and a corrected significance of p=0.05, with responses to word and nonword presentation modeled separately from overt speech.
Results:
Reading aloud accuracy improved by 29% for nonwords (SD=22%, Cohen's d= 1.30, large ES; t(3)=2.62, p=0.04) and 11% for real words (SD=15%, Cohen's d=0.75, medium ES). Western Aphasia Battery Aphasia Quotient (WAB-AQ) improved by a clinically significant (Gilmore et al., 2019) average of 6.28 points (SD=0.71; Cohen's d=1.73, large ES; t(3)=17.70, p<0.001).
After treatment, brain activity increased significantly in the left caudate nucleus, bilateral supramarginal and angular gyri, precuneus, and lateral occipital cortex while reading both words and nonwords (see Pillay et al., 2018 for similar activation areas during reading in an aphasia sample). While reading words only, activation also increased in the right frontal pole and anterior cingulate.
After treatment, brain activity increased significantly in the left caudate nucleus, bilateral supramarginal and angular gyri, precuneus, and lateral occipital cortex while reading both words and nonwords (see Pillay et al., 2018 for similar activation areas during reading in an aphasia sample). While reading words only, activation also increased in the right frontal pole and anterior cingulate.
Conclusions:
Preliminary findings suggest that PMT combined with AET increases bilateral brain activity and improves aphasia outcomes in chronic stroke patients, who are otherwise not expected to spontaneously recover. Nonwords and word stimuli produced slightly different changes in brain activity, with additional right frontal activation for words. While this study does not include a non-aerobic exercise comparison group, we are conducting a randomized controlled trial of combined AET + PMT or Light Stretching + PMT to expand upon these initial findings.
Language:
Reading and Writing 1
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Keywords:
Aphasia
Language
Other - Reading, Stroke, Aerobic Exercise,
1|2Indicates the priority used for review
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