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Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial

INTRODUCTION: Aphasia is one of the most disabling sequelae after stroke, occurring in 25%–40% of stroke survivors. However, there remains a lack of good evidence for the efficacy or mechanisms of speech comprehension rehabilitation. TRIAL DESIGN: This within-subjects trial tested two concurrent int...

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Autores principales: Woodhead, Zoe VJ, Crinion, Jennifer, Teki, Sundeep, Penny, Will, Price, Cathy J, Leff, Alexander P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659142/
https://www.ncbi.nlm.nih.gov/pubmed/28259857
http://dx.doi.org/10.1136/jnnp-2016-314621
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author Woodhead, Zoe VJ
Crinion, Jennifer
Teki, Sundeep
Penny, Will
Price, Cathy J
Leff, Alexander P
author_facet Woodhead, Zoe VJ
Crinion, Jennifer
Teki, Sundeep
Penny, Will
Price, Cathy J
Leff, Alexander P
author_sort Woodhead, Zoe VJ
collection PubMed
description INTRODUCTION: Aphasia is one of the most disabling sequelae after stroke, occurring in 25%–40% of stroke survivors. However, there remains a lack of good evidence for the efficacy or mechanisms of speech comprehension rehabilitation. TRIAL DESIGN: This within-subjects trial tested two concurrent interventions in 20 patients with chronic aphasia with speech comprehension impairment following left hemisphere stroke: (1) phonological training using ‘Earobics’ software and (2) a pharmacological intervention using donepezil, an acetylcholinesterase inhibitor. Donepezil was tested in a double-blind, placebo-controlled, cross-over design using block randomisation with bias minimisation. METHODS: The primary outcome measure was speech comprehension score on the comprehensive aphasia test. Magnetoencephalography (MEG) with an established index of auditory perception, the mismatch negativity response, tested whether the therapies altered effective connectivity at the lower (primary) or higher (secondary) level of the auditory network. RESULTS: Phonological training improved speech comprehension abilities and was particularly effective for patients with severe deficits. No major adverse effects of donepezil were observed, but it had an unpredicted negative effect on speech comprehension. The MEG analysis demonstrated that phonological training increased synaptic gain in the left superior temporal gyrus (STG). Patients with more severe speech comprehension impairments also showed strengthening of bidirectional connections between the left and right STG. CONCLUSIONS: Phonological training resulted in a small but significant improvement in speech comprehension, whereas donepezil had a negative effect. The connectivity results indicated that training reshaped higher order phonological representations in the left STG and (in more severe patients) induced stronger interhemispheric transfer of information between higher levels of auditory cortex. Clinical trial registration This trial was registered with EudraCT (2005-004215-30, https://eudract.ema.europa.eu/) and ISRCTN (68939136, http://www.isrctn.com/).
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spelling pubmed-56591422017-11-03 Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial Woodhead, Zoe VJ Crinion, Jennifer Teki, Sundeep Penny, Will Price, Cathy J Leff, Alexander P J Neurol Neurosurg Psychiatry Cognitive Neurology INTRODUCTION: Aphasia is one of the most disabling sequelae after stroke, occurring in 25%–40% of stroke survivors. However, there remains a lack of good evidence for the efficacy or mechanisms of speech comprehension rehabilitation. TRIAL DESIGN: This within-subjects trial tested two concurrent interventions in 20 patients with chronic aphasia with speech comprehension impairment following left hemisphere stroke: (1) phonological training using ‘Earobics’ software and (2) a pharmacological intervention using donepezil, an acetylcholinesterase inhibitor. Donepezil was tested in a double-blind, placebo-controlled, cross-over design using block randomisation with bias minimisation. METHODS: The primary outcome measure was speech comprehension score on the comprehensive aphasia test. Magnetoencephalography (MEG) with an established index of auditory perception, the mismatch negativity response, tested whether the therapies altered effective connectivity at the lower (primary) or higher (secondary) level of the auditory network. RESULTS: Phonological training improved speech comprehension abilities and was particularly effective for patients with severe deficits. No major adverse effects of donepezil were observed, but it had an unpredicted negative effect on speech comprehension. The MEG analysis demonstrated that phonological training increased synaptic gain in the left superior temporal gyrus (STG). Patients with more severe speech comprehension impairments also showed strengthening of bidirectional connections between the left and right STG. CONCLUSIONS: Phonological training resulted in a small but significant improvement in speech comprehension, whereas donepezil had a negative effect. The connectivity results indicated that training reshaped higher order phonological representations in the left STG and (in more severe patients) induced stronger interhemispheric transfer of information between higher levels of auditory cortex. Clinical trial registration This trial was registered with EudraCT (2005-004215-30, https://eudract.ema.europa.eu/) and ISRCTN (68939136, http://www.isrctn.com/). BMJ Publishing Group 2017-07 2017-03-04 /pmc/articles/PMC5659142/ /pubmed/28259857 http://dx.doi.org/10.1136/jnnp-2016-314621 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Cognitive Neurology
Woodhead, Zoe VJ
Crinion, Jennifer
Teki, Sundeep
Penny, Will
Price, Cathy J
Leff, Alexander P
Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title_full Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title_fullStr Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title_full_unstemmed Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title_short Auditory training changes temporal lobe connectivity in ‘Wernicke’s aphasia’: a randomised trial
title_sort auditory training changes temporal lobe connectivity in ‘wernicke’s aphasia’: a randomised trial
topic Cognitive Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659142/
https://www.ncbi.nlm.nih.gov/pubmed/28259857
http://dx.doi.org/10.1136/jnnp-2016-314621
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