| Authors | Mattioli F, Ambrosi C, Mascaro L, Scarpazza C, Pasquali P, Frugoni M, Magoni M, Biagi L, Gasparotti R |
| Title | Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus: a pilot study |
| Reference | Stroke 2014; 45: 545-552 |
| PMID | 24309584 |
| DOI | 10.1161/strokeaha.113.003192 |
| Language | Italian |
| Inclusion criteria | L MCA; comprehension mildly impaired |
| Number of individuals with aphasia | 12 |
| Number of control participants | 10 |
| Were any of the participants included in any previous studies? | No |
| Is age reported for patients and controls, and matched? | No (range 37-79 years; control ages not reported, though reported to be matched) |
| Is sex reported for patients and controls, and matched? | No (males: 7; females: 5; control sex not stated, but reported to be matched) |
| 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 2.2 ± 1.3 days; T2: mean 16.2 ± 1.3 days; T3: mean 190 ± 25.5 days) |
| To what extent is the nature of aphasia characterized? | Comprehensive battery |
| Language evaluation | AAT, TT |
| Aphasia severity | T1: TT range 2-45; T2: TT range 6-48; T3: TT range 21-48 |
| Aphasia type | T1: 8 Broca's, 3 anomic, 1 Wernicke's; T2: not stated |
| First stroke only? | Yes |
| Stroke type | Not stated |
| To what extent is the lesion distribution characterized? | Individual lesions |
| Lesion extent | Range 4.4-158.3 cc (possibly; units stated do not seem correct) |
| Lesion location | L MCA; lesions seem very small in Supplementary Figure 1, but are described as more extensive in Supplementary Table 1 |
| Participants notes | Treated and untreated groups differed in severity at baseline, albeit not significantly |
| Modality | fMRI |
| Is the study cross-sectional or longitudinal? | Longitudinal—mixed |
| If longitudinal, at what time point(s) were imaging data acquired? | T1: pre-treatment, mean 2.2 ± 1.3 days post onset; T2: post-treatment, mean 16.2 ± 1.3 days post onset; T3: mean 190 ± 25.5 days post onset |
| If longitudinal, was there any intervention between the time points? | 6 patients were randomized to receive treatment focusing on verbal comprehension and lexical retrieval for 1 hour/day, 5 days/week between T1 and T2; no patient received treatment after T2 |
| Is the scanner described? | Yes (Siemens Avanto 1.5 Tesla) |
| Is the timing of stimulus presentation and image acquisition clearly described and appropriate? | No (timing of stimuli not clearly described) |
| Design type | Event-related |
| Total images acquired | 504 |
| Are the imaging acquisition parameters, including coverage, adequately described and appropriate? | No (unclear; number of slices not stated) |
| Is preprocessing and intrasubject coregistration adequately described and appropriate? | Yes |
| Is first level model fitting adequately described and appropriate? | No (model fitting of noise "bip" not clearly described) |
| Is intersubject normalization adequately described and appropriate? | Yes |
| Imaging notes | — |
| Are the conditions clearly described? | No (there is also mention of a noise "bip" that preceded each sentence but details are lacking) |
| Condition | Response type | Repetitions | All groups could do? | All individuals could do? |
|---|---|---|---|---|
| listening to sentences and making a plausibility judgment | Button press | 56 | Yes | Unknown |
| listening to reversed speech | None | 56 | N/A | N/A |
| Conditions notes | Half of the sentences were semantically anomalous |
| Are the contrasts clearly described? | No (see specific limitation(s) below) |
| Language condition | Listening to sentences and making a plausibility judgment |
| Control condition | Listening to reversed speech |
| Are the conditions matched for visual demands? | Yes |
| Are the conditions matched for auditory demands? | Yes |
| 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? | Somewhat |
| Are activations lateralized in the control data? | Yes |
| Control activation notes | 10 participants; quite lateralized activity centered on the anterior Sylvian fissure |
| Contrast notes | It is mentioned that "noise" was also included on the negative side of the contrast; it is unclear if this refers to the noise "bip", which would be inappropriate |
| Are the analyses clearly described? | No* (moderate limitation) (see specific limitation(s) below) |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Cross-sectional between two groups with aphasia |
| Group(s) | Aphasia treated T2 (n = 6) vs untreated T2 (n = 6) |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (groups were different but not due to treatment) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | Clusterwise correction based on arbitrary cluster extent |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .001 |
| Cluster extent | 0.16 cc |
| Statistical details | Methods report cluster extent threshold (we assume this was done), but figure caption states uncorrected |
| Findings | ↑ L IFG pars opercularis ↑ L IFG pars triangularis ↑ L SMA/medial prefrontal ↑ L angular gyrus ↑ R ventral precentral/inferior frontal junction ↑ R supramarginal gyrus |
| Findings notes | Based on coordinates in Table 2 |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Cross-sectional between two groups with aphasia |
| Group(s) | Aphasia treated T3 (n = 6) vs untreated T3 (n = 6) |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (groups were different but not due to treatment) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | Clusterwise correction based on arbitrary cluster extent |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .001 |
| Cluster extent | 0.16 cc |
| Statistical details | Methods report cluster extent threshold (we assume this was done), but figure caption states uncorrected |
| Findings | ↑ L IFG pars triangularis ↑ L insula ↑ L supramarginal gyrus |
| Findings notes | Based on coordinates in Table 2; also increases in R IFG and R supramarginal gyrus but only uncorrected |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal between two groups with aphasia |
| Group(s) | (Aphasia treated (n = 6) T2 vs T1) vs (untreated (n = 6) T2 vs T1) |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (no treatment effect) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No direct comparison |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | — |
| Cluster extent | — |
| Statistical details | Qualitative comparison on p. 548 |
| Findings | ↑ L IFG ↑ R posterior STG ↓ L inferior parietal lobule ↓ R IFG |
| Findings notes | Treated patients showed increases in L IFG and R STG, while untreated patients showed increases in L IPL and R IFG |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal between two groups with aphasia |
| Group(s) | (Aphasia treated (n = 6) T3 vs T2) vs (untreated (n = 6) T3 vs T2) |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (no treatment effect) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No direct comparison |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | — |
| Cluster extent | — |
| Statistical details | Qualitative comparison on p. 548 |
| Findings | None |
| Findings notes | The two groups were reported to have comparable increases in L hemisphere language areas |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia treated (n = 6) T2 vs T1 |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No correction |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .005 |
| Cluster extent | None |
| Statistical details | — |
| Findings | ↑ L IFG pars opercularis ↑ R posterior STG |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia untreated (n = 6) T2 vs T1 |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No correction |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .005 |
| Cluster extent | None |
| Statistical details | — |
| Findings | ↑ L inferior parietal lobule ↑ R insula |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia treated (n = 6) T3 vs T2 |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No correction |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .005 |
| Cluster extent | None |
| Statistical details | — |
| Findings | ↑ L IFG ↑ L insula ↑ L inferior parietal lobule ↑ L anterior temporal ↑ R insula |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia untreated (n = 6) T3 vs T2 |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No correction |
| Software | BrainVoyager QX 1.9 |
| Voxelwise p | .005 |
| Cluster extent | None |
| Statistical details | — |
| Findings | ↑ L IFG pars opercularis ↑ L IFG pars triangularis ↑ L IFG pars orbitalis ↑ L angular gyrus ↑ L superior parietal ↑ L posterior STG/STS/MTG ↑ R IFG pars opercularis ↑ R angular gyrus |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal between two groups with aphasia |
| Group(s) | (Aphasia treated (n = 6) T1 ≠ T2 ≠ T3) vs (untreated (n = 6) T1 ≠ T2 ≠ T3) |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (no treatment effect) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 4 |
| What are the ROI(s)? | (1) L IFG; (2) R IFG; (3) L STG; (4) R STG |
| How are the ROI(s) defined? | Based on functional data from patients and controls, but details not stated; a different set of ROIs are mentioned in the results so it is not really clear which set were actually used |
| Correction for multiple comparisons | No correction |
| Statistical details | — |
| Findings | ↑ L IFG |
| Findings notes | Interaction of time by treatment: treated group showed greater L IFG activity at T2 |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal correlation with language or other measure |
| Group(s) | Aphasia treated (n = 6) T2 vs T1 |
| Covariate | Δ written language (AAT) |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 4 |
| What are the ROI(s)? | (1) L IFG; (2) R IFG; (3) L STG; (4) R STG |
| How are the ROI(s) defined? | Based on functional data from patients and controls, but details not stated; a different set of ROIs are mentioned in the results so it is not really clear which set were actually used |
| Correction for multiple comparisons | No correction |
| Statistical details | — |
| Findings | None |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal correlation with language or other measure |
| Group(s) | Aphasia treated (n = 6) T2 vs T1 |
| Covariate | Δ naming (AAT) |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 4 |
| What are the ROI(s)? | (1) L IFG; (2) R IFG; (3) L STG; (4) R STG |
| How are the ROI(s) defined? | Based on functional data from patients and controls, but details not stated; a different set of ROIs are mentioned in the results so it is not really clear which set were actually used |
| Correction for multiple comparisons | No correction |
| Statistical details | — |
| Findings | ↑ L IFG |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal correlation with language or other measure |
| Group(s) | Aphasia untreated (n = 6) T2 vs T1 |
| Covariate | Δ written language (AAT) |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 4 |
| What are the ROI(s)? | (1) L IFG; (2) R IFG; (3) L STG; (4) R STG |
| How are the ROI(s) defined? | Based on functional data from patients and controls, but details not stated; a different set of ROIs are mentioned in the results so it is not really clear which set were actually used |
| Correction for multiple comparisons | No correction |
| Statistical details | — |
| Findings | None |
| Findings notes | — |
| First level contrast | Listening to sentences and making a plausibility judgment vs listening to reversed speech |
| Analysis class | Longitudinal correlation with language or other measure |
| Group(s) | Aphasia untreated (n = 6) T2 vs T1 |
| Covariate | Δ naming (AAT) |
| 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? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | — |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 4 |
| What are the ROI(s)? | (1) L IFG; (2) R IFG; (3) L STG; (4) R STG |
| How are the ROI(s) defined? | Based on functional data from patients and controls, but details not stated; a different set of ROIs are mentioned in the results so it is not really clear which set were actually used |
| Correction for multiple comparisons | No correction |
| Statistical details | — |
| Findings | ↑ R IFG |
| Findings notes | — |
| Excluded analyses | (1) a visual comparison between all patients at T1, and controls, because there are no specific claims apart from "markedly reduced cortical activation" in patients; (2) pre-treatment comparison between treated and untreated groups |
