title: Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus: a pilot study.
abstract: OBJECTIVE
  Early poststroke aphasia rehabilitation effects and their functional MRI (fMRI) correlates were investigated in a pilot, controlled longitudinal study.
  
  
  METHODS
  Twelve patients with mild/moderate aphasia (8 Broca, 3 anomic, and 1 Wernicke) were randomly assigned to daily language rehabilitation for 2 weeks (starting 2.2 [mean] days poststroke) or no rehabilitation. The Aachen Aphasia Test and fMRI recorded during an auditory comprehension task were performed at 3 time intervals: mean 2.2 (T1), 16.2 (T2), and 190 (T3) days poststroke.
  
  
  RESULTS
  Groups did not differ in terms of age, education, aphasia severity, lesions volume, baseline fMRI activations, and in task performance during fMRI across examinations. Rehabilitated patients significantly improved in naming and written language tasks (P<0.05) compared with no rehabilitation group both at T2 and T3. Functional activity at T1 was reduced in language-related cortical areas (right and left inferior frontal gyrus and middle temporal gyrus, right inferior parietal lobule and superior temporal gyrus) in patients compared with controls. T2 and T3 follow-ups revealed a cortical activation increase, with significantly greater activation in the left hemisphere areas in rehabilitated patients at T2 and T3, and a time×treatment effect at T2 in the left inferior Broca area after rehabilitation. Left inferior frontal gyrus activation at T2 significantly correlated with naming improvement.
  
  
  CONCLUSIONS
  Early poststroke aphasia treatment is useful, has durable effects, and may lead to early enhanced recruitment of brain areas, particularly the left inferior frontal gyrus, which persists in the chronic phase.
authors.affiliation: From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.).
authors.forename: Flavia
authors.initials: F
authors.lastname: Mattioli
authors.forename: Claudia
authors.initials: C
authors.lastname: Ambrosi
authors.forename: Lorella
authors.initials: L
authors.lastname: Mascaro
authors.forename: Cristina
authors.initials: C
authors.lastname: Scarpazza
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pasquali
authors.forename: Marina
authors.initials: M
authors.lastname: Frugoni
authors.forename: Mauro
authors.initials: M
authors.lastname: Magoni
authors.forename: Laura
authors.initials: L
authors.lastname: Biagi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparotti
mesh_terms: D000368:Aged; D001037:Aphasia / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology; D007802:Language; D007807:Language Tests; D007808:Language Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010865:Pilot Projects; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: aphasia; language therapy; magnetic resonance imaging, functional; neuroimaging; rehabilitation outcome