Abstract
The objectives of this study were to test (i) If stroke patients with expressive Aphasia could learn to up-regulate the Blood Oxygenation Level Dependent (BOLD) signal in language areas of the brain, namely Inferior Frontal Gyrus (Broca’s area) and Superior Temporal Gyrus (Wernicke’s area), with real-time fMRI based neurofeedback of the BOLD activation and functional connectivity between the language areas; and (ii) acquired up-regulation could lead to an improvement in expression of language. The study was performed on three groups: Group 1 (n = 4) of Test patients and group 2 (n = 4) of healthy volunteers underwent the neurofeedback training, whereas group 3 (n = 4) of Control patients underwent treatment as usual. Language performance and recovery were assessed using western aphasia battery and picture naming tasks, before and after the neurofeedback training. Results show that the Test group had significant increase in activation of the Broca’s area and its right homologue, while the Normal group achieved the greatest activation during neurofeedback. For the Test group both perilesional and contralateral activations were observed. The improvement in language ability of the test patients was not significantly greater than that of the control patients. Neurofeedback training in Aphasia patients induced significant activation of the Broca’s area, Wernicke’s area and their right homologues, although healthy individuals achieved greater activations in these regions than the patient groups. Training also activated perilesional areas of Rolandic operculum, precentral gyrus and postcentral gyrus for the Test patients significantly. However, lack of behavioral and symptom modifications in the Test group calls for improvements in the efficacy of the approach.
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Acknowledgments
The authors thank the MRI technologists of Department of Imaging Sciences and Interventional Radiology, SCTIMST for help in performing the MRI scans; and Speech Therapists of Stroke Clinic, Department of Neurology, SCTIMST for administering speech and psychological tests. This study was funded by the Department of Biotechnology and the Department of Science & Technology, Government of India.
Funding
This study was funded by Department of Biotechnology (BT/PR14032/Med/30/331/2010) and the Department of Science and Technology, (DST/INT/CP-STIO/2007–2008(8)/2008) Government of India. Author R.S. was supported by Comisión Nacional de Investigación Científica y Tecnológica de Chile (Conicyt) through Fondo Nacional de Desarrollo Científico y Tecnológico, Fondecyt Postdoctoral grant (No. 3100648) Fondecyt Regular (projects n◦ 1171313 and n◦ 117132) and CONICYT PIA/Anillo de Investigación en Ciencia y Tecnología ACT172121.
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Author Sujesh S. declares that he has no conflict of interest. Author Anuvitha C. declares that she has no conflict of interest. Author Y. Vijay Raj declares that he has no conflict of interest. Author Sylaja P. N. declares that she has no conflict of interest. Author Kesavadas C. declares that he has no conflict of interest. Author Ranganatha S. declares that he has no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were approved by the Institutional Ethics Committee (IEC) of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. The IEC is organized and operated according to the requirements of Good Clinical Practice and the requirements of the Indian Council of Medical Research (ICMR).
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Informed consent was obtained from all individual participants included in the study. The clinical trial has been registered with identification No. CTRI/2018/02/012155 in the clinical trial registry of India (www.ctri.nic.in).
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Sreedharan, S., Chandran, A., Yanamala, V.R. et al. Self-regulation of language areas using real-time functional MRI in stroke patients with expressive aphasia. Brain Imaging and Behavior 14, 1714–1730 (2020). https://doi.org/10.1007/s11682-019-00106-7
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DOI: https://doi.org/10.1007/s11682-019-00106-7