title: Regional changes in word-production laterality after a naming treatment designed to produce a rightward shift in frontal activity.
abstract: Five nonfluent aphasia patients participated in a picture-naming treatment that used an intention manipulation (opening a box and pressing a button on a device in the box with the left hand) to initiate naming trials and was designed to re-lateralize word production mechanisms from the left to the right frontal lobe. To test the underlying assumption regarding re-lateralization, patients participated in fMRI of category-member generation before and after treatment. Generally, the four patients who improved during treatment showed reduced frontal activity from pre- to post-treatment fMRI with increasing concentration of activity in the right posterior frontal lobe (motor/premotor cortex, pars opercularis), demonstrating a significant shift in lateraliity toward the right lateral frontal lobe, as predicted. Three of these four patients showed no left frontal activity by completion of treatment, indicating that right posterior lateral frontal activity supported category-member generation. Patients who improved in treatment showed no difference in lateralization of lateral frontal activity from normal controls pre-treatment, but post-treatment, their lateral frontal activity during category-member generation was significantly more right lateralized than that of controls. Patterns of activity pre- and post-treatment suggested increasing efficiency of cortical processing as a result of treatment in the four patients who improved. The one patient who did not improve during treatment showed a leftward shift in lateral frontal lateralization that was significantly different from the four patients who did improve. Neither medial frontal nor posterior perisylvian re-lateralization from immediately pre- to immediately post-treatment images was a necessary condition for significant treatment gains or shift in lateral frontal lateralization. Of the three patients who improved and in whom posterior perisylvian activity could be measured at post-treatment fMRI, all maintained equal or greater amounts of left-hemisphere perisylvian activity as compared to right. This finding is consistent with reviews suggesting both hemispheres are involved in recovery of language in aphasia patients.
authors.affiliation: VA RR&D Brain Rehabilitation Research Center, Gainesville, FL, USA. nossorc1@phhp.ufl.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Crosson
authors.forename: Anna Bacon
authors.initials: AB
authors.lastname: Moore
authors.forename: Keith M
authors.initials: KM
authors.lastname: McGregor
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Chang
authors.forename: Michelle
authors.initials: M
authors.lastname: Benjamin
authors.forename: Kaundinya
authors.initials: K
authors.lastname: Gopinath
authors.forename: Megan E
authors.initials: ME
authors.lastname: Sherod
authors.forename: Christina E
authors.initials: CE
authors.lastname: Wierenga
authors.forename: Kyung K
authors.initials: KK
authors.lastname: Peck
authors.forename: Richard W
authors.initials: RW
authors.lastname: Briggs
authors.forename: Leslie J Gonzalez
authors.initials: LJ
authors.lastname: Rothi
authors.forename: Keith D
authors.initials: KD
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D001039:Aphasia, Broca / Q000503:physiopathology / Q000534:rehabilitation*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D033182:Intention; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009275:Names; D010364:Pattern Recognition, Visual / Q000502:physiology; D010775:Photic Stimulation; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function; D013068:Speech Production Measurement; D016896:Treatment Outcome