Self-regulation of language areas using real-time functional MRI in stroke patients with expressive aphasia
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ORIGINAL RESEARCH
Self-regulation of language areas using real-time functional MRI in stroke patients with expressive aphasia Sujesh Sreedharan 1 & Anuvitha Chandran 2 & Vijay Raj Yanamala 1 & PN Sylaja 2 & Chandrasekharan Kesavadas 3 & Ranganatha Sitaram 4,5
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The objectives of this study were to test (i) If stroke patients with expressive Aphasia could learn to up-regulate the Blood Oxygenation Level Dependent (BOLD) signal in language areas of the brain, namely Inferior Frontal Gyrus (Broca’s area) and Superior Temporal Gyrus (Wernicke’s area), with real-time fMRI based neurofeedback of the BOLD activation and functional connectivity between the language areas; and (ii) acquired up-regulation could lead to an improvement in expression of language. The study was performed on three groups: Group 1 (n = 4) of Test patients and group 2 (n = 4) of healthy volunteers underwent the neurofeedback training, whereas group 3 (n = 4) of Control patients underwent treatment as usual. Language performance and recovery were assessed using western aphasia battery and picture naming tasks, before and after the neurofeedback training. Results show that the Test group had significant increase in activation of the Broca’s area and its right homologue, while the Normal group achieved the greatest activation during neurofeedback. For the Test group both perilesional and contralateral activations were observed. The improvement in language ability of the test patients was not significantly greater than that of the control patients. Neurofeedback training in Aphasia patients induced significant activation of the Broca’s area, Wernicke’s area and their right homologues, although healthy individuals achieved greater activations in these regions than the patient groups. Training also activated perilesional areas of Rolandic operculum, precentral gyrus and postcentral gyrus for the Test patients significantly. However, lack of behavioral and symptom modifications in the Test group calls for improvements in the efficacy of the approach. Keywords Real-time fMRI . Neurofeedback training . Aphasia . Self-regulation . Neurorehabilitation
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11682-019-00106-7) contains supplementary material, which is available to authorized users. * Ranganatha Sitaram [email protected] 1
Medical Device Engineering, Biomedical Technology Wing, SCTIMST, Thiruvananthapuram, India
2
Department of Neurology, SCTIMST, Thiruvananthapuram, India
3
Department of Imaging Sciences and Interventional Radiology, SCTIMST, Thiruvananthapuram, India
4
Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
5
Laboratory for Brain-Machine Interfaces and Neuromodulation, and Department of Psychiatry and Neuroscience, Faculties of Engineering, Biology & Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Stroke is the leading
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