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Sponsors and Collaborators: |
Department of Veterans Affairs Boston University |
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Information provided by: | Department of Veterans Affairs |
ClinicalTrials.gov Identifier: | NCT00467103 |
The purpose of this research is to utilize functional magnetic resonance imaging (fMRI) to investigate brain reorganization for language behavior in stroke patients with aphasia. A primary focus of the study is on recovery of nonfluent propositional speech and naming in chronic aphasia patients. The fMRI technique is used to examine activation in the left hemisphere (LH) and right hemisphere (RH), during recovery of specific language behaviors in chronic nonfluent aphasia patients.
Condition |
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Aphasia Nonfluent Aphasia Stroke |
Study Type: | Observational |
Study Design: | Cohort, Prospective |
Official Title: | Neural Networks and Language Recovery in Aphasia From Stroke: fMRI Studies |
Estimated Enrollment: | 80 |
Study Start Date: | October 1999 |
Estimated Study Completion Date: | March 2011 |
Estimated Primary Completion Date: | September 2010 (Final data collection date for primary outcome measure) |
Groups/Cohorts |
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1
Chronic Stroke patients with Nonfluent Aphasia
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2
Age-matched Normal Controls
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PURPOSE: The purpose of this 4-year fMRI research is to study brain reorganization for language in patients with left hemisphere (LH) stroke who have chronic nonfluent aphasia. This fMRI research is fundamental and critical to the PI's NIH RO1 grant, Transcranial Magnetic Stimulation (TMS) to Improve Speech in nonfluent aphasia, which was recently renewed for 5 years, 2006-11. There is no overlap in the studies. The NIH grant provides the TMS (real and sham). This VA grant provides 4 different fMRI tasks performed pre- and post- a series of TMS treatments (real and sham) - Overt Naming fMRI; Overt Propositional Speech fMRI; and Nonverbal Semantic Decision tasks for Nouns, and for Actions.
We have observed that application of TMS to an anterior portion of right (R) Broca's homologue (pars triangularis, PTr), results in significantly improved picture naming ability at 2 and 8 Mo. after the last (10th) TMS treatment, in aphasia patients who began TMS at 5-11 years poststroke. Also, half of these nonfluent aphasia patients improved their Phrase Length in propositional speech, post-TMS.
RATIONALE: We and others have observed that patients with chronic, nonfluent aphasia (poor, hesitant speech) have overactivation of R hemisphere (RH) cortical language homologues. We hypothesize this represents a maladaptive plasticity and probably poor active inhibition during speech. Slow, 1 Hz TMS can be used to suppress cortical excitability. Our goal is to use 1 Hz TMS to inhibit/suppress the overactivation in RH language homologues. Our early TMS research has shown that suppression of R PTr in these patients is associated with improved speech. The fMRI studies proposed in this VA grant will help to investigate the neurophysiological changes underlying improvement post- TMS in propositional speech and in nonverbal semantic decision tasks. The new MRI technique, diffusion tensor imaging (DTI) will be used to study WM pathways subjacent to cortex treated with TMS.
DESIGN: Randomized, sham-control, incomplete crossover design with 32 patients (16 mild-moderate; 16 severe nonfluent), half receive real TMS series only; half, sham TMS 1st, and real 2nd. Language, Neuropsych. testing, and fMRIs are performed at Entry, and at 2 Mo. post-10 real or sham TMS treatments; and at 6 Mo. post real. There are 4 Projects: 1) fMRI during overt naming and propositional speech (Overt Picture Naming and Picture Descriptions/Story Telling; 2) fMRI during a Nonverbal Semantic Decision Task with Superordinate Noun Icons; 3) fMRI during a Nonverbal Semantic Decision Task with Action and Object Icons; 4) DTI. DTI is performed only at Entry (all subjects). Normal controls (n=8) do not receive TMS; they are studied with fMRI at Entry, at 2 and 6 Mo. later.
HYPOTHESES: Following the real TMS to suppress R PTr, there will be less overactivation on fMRI (better modulation) in RH language homologues, and new LH activation (including L perilesional areas and L SMA). This will be associated with improved propositional speech (BDAE) and nonverbal semantic decision ability at 2 and 6 Mo. post-real TMS. No language or fMRI changes are expected post-sham TMS. The fMRIs performed 3x with the normal controls are not expected to show change, but will document the neural networks for the fMRI tasks.
Ages Eligible for Study: | 45 Years to 80 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | Yes |
Sampling Method: | Non-Probability Sample |
Chronic stroke patients with nonfluent aphasia
Inclusion Criteria:
Exclusion Criteria:
Contact: Paula I Martin, BS | (857) 364-4029 | paulak@bu.edu |
Contact: Michael Ho, PhD | (857) 364-2213 | mikeho@bu.edu |
United States, Massachusetts | |
VA Medical Center, Jamaica Plain Campus | Recruiting |
Boston, Massachusetts, United States, 02130 | |
Contact: Gary Park, BA 857-364-6564 gary.park@va.gov | |
Contact: Liza M Catucci, BA (857) 364-6252 liza.catucci@va.gov | |
Principal Investigator: Margaret Naeser, PhD |
Principal Investigator: | Margaret Naeser, PhD | VA Medical Center, Jamaica Plain Campus |
Responsible Party: | Department of Veterans Affairs ( Naeser, Margaret - Principal Investigator ) |
Study ID Numbers: | MHBB-006-06S |
Study First Received: | April 25, 2007 |
Last Updated: | August 25, 2008 |
ClinicalTrials.gov Identifier: | NCT00467103 |
Health Authority: | United States: Federal Government |
Adult Aphasia Diffusion Tensor Imaging functional Magnetic Resonance Imaging |
Language Recovery Left Middle Cerebral Artery Stroke Nonfluent Aphasia |
Speech Disorders Cerebral Infarction Aphasia Aphasia, Broca Stroke Vascular Diseases Central Nervous System Diseases Language Disorders Ischemia Brain Diseases |
Cerebrovascular Disorders Signs and Symptoms Infarction, Middle Cerebral Artery Brain Ischemia Neurologic Manifestations Brain Infarction Infarction Neurobehavioral Manifestations Communication Disorders |
Nervous System Diseases Cardiovascular Diseases |