fMRI of Language Recovery Following Stroke in Adults

Aphasia (difficulty speaking) is one of the most dreaded consequences of stroke. It is
associated with high mortality and severe motor, social, and cognitive disability. During the
past decade, therapies administered by stroke teams have made great strides in limiting the
damage due to a stroke. Unfortunately, progress in aphasia rehabilitation has not experienced
the same rapid advancement. Evidence suggests that the brain may have untapped potential for
recovery of aphasia after stroke.

Using functional magnetic resonance imaging (fMRI), researchers now are able to examine the
areas of the brain that are responsible for language recovery after stroke. Such data may
explain how the brain recovers after stroke, and may lead to new therapies to help
individuals who have suffered an aphasia-causing stroke.

In this study, researchers will examine the changes the brain undergoes while recovering from
an aphasia-causing stroke and the mechanisms that underlie such recovery, and test the
effectiveness of a new and promising method of aphasia rehabilitation called
constraint-induced aphasia therapy (CIAT). The scientists will perform fMRI studies of brain
activation in people who have suffered an aphasia-causing stroke in order to better
understand the underlying mechanisms of recovery from aphasia. Specifically the researchers
will compare language activation between adults with stroke and children with perinatal and
postnatal stroke (from previous studies); map changes in language activation, characterize
the patterns of language reorganization that occur following stroke; and use the fMRI
measures to assess recovery using CIAT.

The study will last one year, during this time participants will have language testing to
evaluate the degree of aphasia and its recovery; and five fMRI scans scheduled at 2 weeks, 6
weeks, 12 weeks, 26 weeks, and 56 weeks. Participants with remaining moderate aphasia will be
offered a chance to participate in an extension treatment study that will last up to 3 months
(STUDY).

A better understanding of brain changes during recovery from aphasia may help develop new
methods to improve recovery.

Inclusion Criteria:

- MCA stroke as indicated by the presence of aphasia and MRI lesion in the LMCA
distribution

- Moderate aphasia (Token Test score between 40th and 90th percentile)

- Written informed consent by the patient or the next of kin

Exclusion Criteria:

- Underlying degenerative or metabolic disorder or supervening medical illness

- Severe depression or other psychiatric disorder

- Pregnancy

- Any contraindication to an MRI procedure (i.e., metal implants, claustrophobia)