Aphasia Neuroplasticity Review

Karbe et al. (1998)

Reference

AuthorsKarbe H, Thiel A, Weber-Luxenburger G, Herholz K, Kessler J, Heiss WD
TitleBrain plasticity in poststroke aphasia: what is the contribution of the right hemisphere?
ReferenceBrain Lang 1998; 64: 215-230
PMID9710490
DOI10.1006/brln.1998.1961

Participants

LanguageGerman
Inclusion criteriaMCA; able to repeat single words
Number of individuals with aphasia12
Number of control participants10
Were any of the participants included in any previous studies?No
Is age reported for patients and controls, and matched?No (mean 57 years, range 34-78 years; controls not matched for age)
Is sex reported for patients and controls, and matched?Yes (males: 7; females: 5; stated to be not matched, but difference not significant)
Is handedness reported for patients and controls, and matched?Yes (right: 12; left: 0)
Is time post stroke onset reported and appropriate to the study design?Yes (T1: mean 24 ± 11 days, ~3-4 weeks; T2: mean 19 ± 2 months, > 1 year)
To what extent is the nature of aphasia characterized?Severity and type
Language evaluationTT
Aphasia severityT1: 9 severe; 2 mild; 1 not stated; TT range 3-47 errors; T2: not stated
Aphasia typeT1: 8 global, 3 anomic, 1 Wernicke's; T2: not stated
First stroke only?Yes
Stroke typeIschemic only
To what extent is the lesion distribution characterized?Extent and location
Lesion extentRange 2-133 cc
Lesion locationL MCA
Participants notesOnly 7 of the 12 patients took part at T2

Imaging

ModalityPET (rCMRgl)
Is the study cross-sectional or longitudinal?Longitudinal—recovery
If longitudinal, at what time point(s) were imaging data acquired?T1: mean 24 ± 11 days, ~3-4 weeks; T2: mean 19 ± 2 months, > 1 year
If longitudinal, was there any intervention between the time points?Not stated
Is the scanner described?Yes (CTI-Siemens ECAT EXACT HR)
Is the timing of stimulus presentation and image acquisition clearly described and appropriate?No* (moderate limitation) (activation and control images not acquired on the same day; number of acquisitions not clearly described)
Design typePET
Total images acquired8
Are the imaging acquisition parameters, including coverage, adequately described and appropriate?Yes (whole brain)
Is preprocessing and intrasubject coregistration adequately described and appropriate?Yes
Is first level model fitting adequately described and appropriate?Yes
Is intersubject normalization adequately described and appropriate?N/A—no intersubject normalization
Imaging notes

Conditions

Are the conditions clearly described?Yes
ConditionResponse typeRepetitionsAll groups could do?All individuals could do?
word repetitionWord (overt)4 (?)UnknownUnknown
restNone4 (?)N/AN/A
Conditions notesInability to repeat single words was an exclusion criterion, but many patients had severe aphasia so it is unclear how they would have performed

Contrasts

Are the contrasts clearly described?Yes

Contrast 1: word repetition vs rest

Language conditionWord repetition
Control conditionRest
Are the conditions matched for visual demands?Yes
Are the conditions matched for auditory demands?No
Are the conditions matched for motor demands?No
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Is reaction time matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Behavioral data notes
Are control data reported in this paper or another that is referenced?Somewhat
Does the contrast selectively activate plausible relevant language regions in the control group?No
Are activations lateralized in the control data?No
Control activation notesROIs only; negligible evidence of lateralization
Contrast notes

Analyses

Are the analyses clearly described?No* (moderate limitation) (see specific limitation(s) below)

ROI analysis 1

First level contrastWord repetition vs rest
Analysis classCross-sectional aphasia vs control
Group(s)Aphasia T1 vs control
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeAnatomical
How many ROIs are there?8
What are the ROI(s)?(1) L IFG; (2) L STG/HG; (3) L SMA; (4) L ventral precentral; (5-8) homotopic counterparts
How are the ROI(s) defined?Individual anatomical images
Correction for multiple comparisonsNo direct comparison
Statistical detailsQualitative comparison on p. 219, but only the L SMA comparison is explicitly quantified
Findings↑ L SMA/medial prefrontal
↑ R SMA/medial prefrontal
↓ L posterior STG
↓ L Heschl's gyrus
Findings notes

ROI analysis 2

First level contrastWord repetition vs rest
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) T1 (n = 7)
CovariateTT T1
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (TT not optimal measure of overall language function)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeAnatomical
How many ROIs are there?8
What are the ROI(s)?(1) L IFG; (2) L STG/HG; (3) L SMA; (4) L ventral precentral; (5-8) homotopic counterparts
How are the ROI(s) defined?Individual anatomical images
Correction for multiple comparisonsNo correction
Statistical details
FindingsNone
Findings notes

ROI analysis 3

First level contrastWord repetition vs rest
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) T2 (n = 7)
CovariateTT T2
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (TT not optimal measure of overall language function)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeAnatomical
How many ROIs are there?8
What are the ROI(s)?(1) L IFG; (2) L STG/HG; (3) L SMA; (4) L ventral precentral; (5-8) homotopic counterparts
How are the ROI(s) defined?Individual anatomical images
Correction for multiple comparisonsNo correction
Statistical details
Findings↓ L SMA/medial prefrontal
↓ R ventral precentral/inferior frontal junction
↓ R SMA/medial prefrontal
↓ R posterior STG
↓ R Heschl's gyrus
Findings notesMore activation in patients with more severe aphasia per TT

ROI analysis 4

First level contrastWord repetition vs rest
Analysis classLongitudinal correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) (n = 7) T2 vs T1
CovariateSubsequent outcome (T2) TT
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?No (the logic behind correlating activation changes and language outcome is unclear; TT not optimal measure of overall language function)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegion of interest (ROI)
ROI typeAnatomical
How many ROIs are there?1
What are the ROI(s)?L STG/HG
How are the ROI(s) defined?Individual anatomical images
Correction for multiple comparisonsOne only
Statistical details
Findings↑ L posterior STG
↑ L Heschl's gyrus
Findings notesIncrease in activation for repetition was correlated with better aphasia outcome per TT

ROI analysis 5

First level contrastWord repetition vs rest
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) T2 (n = 7)
CovariatePrevious Δ (T2 vs T1) activation in L STG/HG
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?No (logically problematic because patients with less severe initial aphasia would also be expected to show little L temporal increase, but would not be expected to show R temporal recruitment)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeAnatomical
How many ROIs are there?4
What are the ROI(s)?(1) R IFG; (2) R STG/HG; (3) R SMA; (4) R ventral precentral
How are the ROI(s) defined?Individual anatomical images
Correction for multiple comparisonsNo correction
Statistical details
Findings↓ R IFG
↓ R ventral precentral/inferior frontal junction
↓ R SMA/medial prefrontal
↓ R posterior STG
↓ R Heschl's gyrus
Findings notesPatients with more increase in L STG/HG activation showed less activation of R hemisphere regions at T2

Notes

Excluded analysesThe "Initial study" columns of table 3, because they are not described in the text and it is not clear exactly what is being correlated with what