Using fMRI and Behavioural Measures to Investigate Rehabilitation in Post-Stroke Aphasic Deficits

Abstract

In this thesis I investigated whether an intensive computerised, home-based therapy programme could improve phonological discrimination ability in 19 patients with chronic post-stroke aphasia. One skill specifically targeted by the treatment demonstrated an improvement due to the therapy. However, this improvement did not generalise to untreated items, and was only effective for participants without a lesion involving the frontal lobe, indicating a potentially important role for this region in determining outcome of aphasia therapy.

Complementary functional imaging studies investigated activity in domain-general and domain-specific networks in both patients and healthy volunteers during listening and repeating simple sentences. One important consideration when comparing a patient group with a healthy population is the difference in task difficulty encountered by the two groups. Increased cognitive effort can be expected to increase activity in domain-general networks. I minimised the effect of this confound by manipulating task difficulty for the healthy volunteers to reduce their behavioural performance so that it was comparable to that of the patients. By this means I demonstrated that the activation patterns in domain-general regions were very similar in the two groups. Region-of-interest analysis demonstrated that activity within a domain-general network, the salience network, predicted residual language function in the patients with aphasia, even after accounting for lesion volume and their chronological age.

I drew two broad conclusions from these studies. First, that computer-based rehabilitation can improve disordered phonological discrimination in chronic aphasia, but that lesion distribution may influence the response to this training. Second, that the ability to activate domain-general cognitive control regions influences outcome in aphasia. This allows me to propose that in future work, therapeutic strategies, pharmacological or behavioural, targeting domain-general brain systems, may benefit aphasic stroke rehabilitation.