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Neuroscience insights improve neurorehabilitation of poststroke aphasia

Nature Reviews Neurology volume 7, pages 86–97 (2011)Cite this article

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Abstract

The treatment of aphasias—acquired language disorders—caused by stroke and other neurological conditions has benefitted from insights from neuroscience and neuropsychology. Hebbian mechanisms suggest that massed practice and exploitation of residual neurological capacities can aid neurorehabilitation of patients with poststroke aphasia, and progress in basic neuroscience research indicates that the language system of the human brain is functionally interwoven with perceptual and motor systems. Intensive speech and language therapies, including constraint-induced aphasia therapy, that activate both the linguistic and concordant motor circuits utilize the knowledge gained from these advances in neuroscience research and can lead to surprisingly rapid improvements in language performance, even in patients with chronic aphasia. Drug-based therapies alone and in conjunction with behavioral language therapies also increase language performance in patients with aphasia. Furthermore, noninvasive transcranial magnetic stimulation and electrical stimulation techniques that target neuronal activity within perilesional areas might help patients with aphasia to regain lost language functions. Intensive language–action therapies that lead to rapid improvements in language skills might provide a new opportunity for investigating fast plastic neuronal changes in the areas of the brain associated with language processing. Here, we review progress in basic neuroscience research and its translational impact on the neurorehabilitation of language disorders after stroke.

Key Points

  • Advances in neuroscience research have led to the development of novel treatments for poststroke aphasia

  • Intensive language–action therapy, pharmacological interventions and noninvasive brain stimulation can enhance language performance in patients with poststroke aphasia

  • Intensive language–action therapy can improve language performance of patients with aphasia several years after a stroke episode

  • Constraint-induced aphasia therapy is more effective than conventional speech–language therapy at treating chronic poststroke aphasia

  • Drug therapies targeting linguistic and cognitive disorders can augment functional improvements associated with intensive language–action therapy

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Figure 1: Brain areas involved in language processing.
Figure 2: CIAT for chronic poststroke aphasia.
Figure 3: Selected brainstem and basal forebrain nuclei and their major ascending monoaminergic and cholinergic projections.
Figure 4: Changes in brain activity over 2 weeks of CIAT in patients with chronic poststroke aphasia.

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Acknowledgements

The study was supported by the Ministerio de Educación y Ciencia, Spain (grant SEJ2007-67,793) and the Medical Research Council, UK (grants U1055.04.003.00001.01 and MC_US_A060_0034).

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Calle del Marques de Beccaria 3, Campus Teatinos, 29010, Malaga, Spain

    Marcelo L. Berthier

  2. MRC Cognition and Brain Sciences Unit (CBU), 15 Chaucer Road, CB2 7EF, Cambridge, UK

    Friedemann Pulvermüller

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Contributions

M. L. Berthier and F. Pulvermüller researched the data and wrote the article, and provided substantial contributions to discussions of the content, reviewing and editing of the manuscript.

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Correspondence to Marcelo L. Berthier or Friedemann Pulvermüller.

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Competing interests

M. L. Berthier has received honoraria from Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Merz, Novartis and Pfizer for consulting, and received honoraria from Janssen, Lundbeck, Merz and Pfizer for lectures. He has also received research funding from Eisai, Merz and Pfizer. F. Pulvermüller has received research funding from GlaxoSmithKline.

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Supplementary Table 1

Studies of constraint-induced aphasia therapy in poststroke aphasia (DOC 133 kb)

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Berthier, M., Pulvermüller, F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol 7, 86–97 (2011). https://doi.org/10.1038/nrneurol.2010.201

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