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La evanescencia de las lenguas aborígenes se aceleró durante las últimas décadas del siglo pasado, estimándose que en la presente centuria desaparecerán más de la mitad de los 4000 idiomas existentes. Lamentablemente no existen reportes favorables acerca de experiencias de recuperación y revitalización lingüística, por lo que se deben tomar medidas urgentes. En algunos territorios estos idiomas se ven relegados a la condición de dialectos y están desvalorizadas en relación con el lenguaje nacional, lo cual las condena a una muerte segura. El objetivo de este trabajo consiste en explorar sobre la variedad dialectal del Quichua Santiagueño haciendo hincapié en el aspecto lingüístico y socio histórico. The evanescence of aboriginal languages ??accelerated during the last decades of the last century, estimating that in the present century more than half of the 4,000 languages ??will disappear. Unfortunately, there are no favorable reports about language recovery and revitalization experiences, so urgent measures must be taken. In some territories, these languages ??are relegated to the status of dialects and are devalued in relation to the national language, which means death to certain death. The aim of this essay is to explore the Quichua Santiagueño variety and linguistic policies A evanescência das línguas aborígines acelerou-se durante as últimas décadas do século passado, e estima-se que mais da metade das 4.000 línguas existentes desaparecerão neste século. Infelizmente, não há relatórios favoráveis sobre experiências de recuperação e revitalização lingüística, e são necessárias ações urgentes. Em alguns territórios, esses idiomas são relegados ao status de dialetos e são desvalorizados em relação ao idioma nacional, o que os condena à morte certa. O objetivo deste trabalho é explorar a variedade dialetal do Quichua Santiagueño com ênfase nos aspectos lingüísticos e sócio-históricos.

Este artigo é parte do meu percurso acadêmico na Licenciatura Intercultural Indígena da UFMG, em 2018, sobre a Língua Pataxó Hãhãhãe. O povo Pataxó Hãhãhãe tem uma população de quase quatro mil indígenas e habita no Território Indígena Caramuru Catarina Paraguaçu que faz divisa com os três municípios do sul da Bahia: Itaju do Colônia, Pau Brasil e Camacan. Até o ano de 1938, o povo Pataxó Hãhãhãe falava somente sua língua ancestral. A perseguição contra esse povo, fez com que de maneira forçada deixasse de falar sua própria língua. Bahetá foi a última falante da língua, faleceu em 1992. Em 1982 foi publicada a cartilha Lições de Bahetá, com 129 palavras e duas frases, coletadas com a anciã Bahetá. No ano de 2017 foi publicado um Dicionário do Povo Pataxó Hãhãhãe trazendo um novo horizonte ao vocabulário do meu povo, com informações sobre outras línguas com as quais os Hãhãhãe tiveram contato, como Kamakã, Kariri Sapuyá, Tupinambá e Pataxó. Neste artigo trago a experiência Pataxó Hãhãhãe de retomada ou reavivamento da língua deixada pelos nossos anciões e como tem sido esse processo no contexto escolar, a partir da reflexão sobre uma proposta de ensino desenvolvida na Escola Indígena da Aldeia Bahetá. Para realizar a pesquisa, foram feitas consultas em arquivo públicos, pesquisa de trabalhos publicados sobre a língua Pataxo Hãhãhãe, além de pesquisa de campo com coleta de depoimentos de anciões. Espera-se que esse trabalho ajude na luta pela retomada língua Pataxó Hãhãhãe e estimule outras gerações a usar a língua valorizando as memórias de Bahetá, Txitxiáh, bem como os saberes dos mais velhos que vêm nos alimentando através da fala.

Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.

Background: Group therapy has shown benefit in language recovery in patients with aphasia (PWA). However, many in the field question its role in improving quality of life for PWA, as well as whethe...

Brain imaging methods such as functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) have already been used to decipher the functional and structural brain changes occurring during normal language development. However, little is known about the differentiation of the language network after an early lesion. While in adults, stroke over the left hemisphere generally induces post-stroke aphasia, it is not always the case when a stroke occurs in the perinatal period, thus revealing a remarkable plastic power of the language network during early development. In particular, the role of perilesional tissues, as opposed to undamaged brain areas in the functional recovery of language functions after an early insult, remains unclear. In this review article, we provide an overview of the extant literature using functional and structural neuroimaging data revealing the signatures of brain plasticity underlying near-normal language development.

Significance Studies of healthy and impaired language have generated many verbally described hypotheses. While these verbal descriptions have advanced our understanding of language processing, some explanations are mutually incompatible, and it is unclear how they work mechanistically. We constructed a neurocomputational bilateral model of spoken language production to simulate a range of phenomena in healthy participants and patients with aphasia simultaneously, including language lateralization, impaired performance after left but not right damage, and hemispheric involvement in plasticity-dependent recovery. The model demonstrates how seemly contradictory findings can be simulated within a single framework. This provides a coherent mechanistic account of language lateralization and recovery from poststroke aphasia., Understanding the processes underlying normal, impaired, and recovered language performance has been a long-standing goal for cognitive and clinical neuroscience. Many verbally described hypotheses about language lateralization and recovery have been generated. However, they have not been considered within a single, unified, and implemented computational framework, and the literatures on healthy participants and patients are largely separated. These investigations also span different types of data, including behavioral results and functional MRI brain activations, which augment the challenge for any unified theory. Consequently, many key issues, apparent contradictions, and puzzles remain to be solved. We developed a neurocomputational, bilateral pathway model of spoken language production, designed to provide a unified framework to simulate different types of data from healthy participants and aphasic patients. The model encapsulates key computational principles (differential computational capacity, emergent division of labor across pathways, experience-dependent plasticity-related recovery) and provides an explanation for the bilateral yet asymmetric lateralization of language in healthy participants, chronic aphasia after left rather than right hemisphere lesions, and the basis of partial recovery in patients. The model provides a formal basis for understanding the relationship between behavioral performance and brain activation. The unified model is consistent with the degeneracy and variable neurodisplacement theories of language recovery, and adds computational insights to these hypotheses regarding the neural machinery underlying language processing and plasticity-related recovery following damage.

Transcranial Direct Current Stimulation (tDCS) is an adjunct to behavioral speech therapy to enhance the recovery of post-stroke dysphasia. Administration of tDCS involves the application of low- amplitude electrical currents through surface electrodes, which are placed onto the scalp to influence the neuronal activity.TDCS montage and patients' clinical characteristics are the important factors in determining the outcome of the intervention. We aim to describe the clinical characteristics, outcomes and local limitation factors of five post-stroke patients who received TDCS combined with behavioural therapy for dysphasia. All patients, except for Case #5 showed improvement at day 10 post-intervention in several speech and language domains. TDCS is a promising adjunctive intervention in enhancing neuroplasticity activity in a post-stroke brain. A further well design case-controlled study is warranted to prove its efficacy in our local population. Local factors and limitations that may influence the outcome should be considered.

Stroke in the language dominant hemisphere is the most frequent cause of aphasia. In the course of post-stroke aphasia different mechanisms can contribute to the recovery of language: recovery from ischemia, compensatory rerouting of language modalities and neuroplasticity occur at different time scales after the initial injury. These mechanisms may occur spontaneously or may be induced or influenced by various therapeutic interventions. This report contains a systematic review of the literature concerning the debated role of the right hemisphere in the recovery from stroke-related aphasia. The existing literature was approached using the PICOS principle and well-established inclusion and exclusion criteria. Although many gaps remain in the knowledge on the role of the right hemisphere, there is some evidence of a facilitation of spontaneous language recovery in the acute and subacute phase. In the subacute and chronic phase, the right hemisphere homologous language areas, along with memory and attention-related areas, facilitate treatment related improvement. In contrast, in therapy-free periods in the chronic stage, the right hemisphere no longer contributes to language recovery or may even be inhibitory. Injury-, language- and therapy-related variables impact on the role of the right hemisphere in aphasia recovery.

Background: Individuals with aphasia show difficulty producing sentences as a result of impaired syntactic production. Studies of structural priming in healthy speakers show that long-term ...

Traditional descriptions of aphasia have ascribed language disturbances to tissue damage but symptoms expressed as repetitive verbal behaviors such as echolalia, perseverations and so forth, cannot emanate from fully dysfunctional. We propose that in aphasia, repetitive verbal behaviors (such as conduite d’approche (CdA) and mitigated echolalia (ME)) may be compensatory behaviors emerging from ongoing plastic changes occurring in the preserved tissue. CdA is the repetitive and self-initiated approximation to a target word during spontaneous speech or naming tasks. ME refers to the echoing of a just heard sentence introducing a subtle change. At brain level, language deficits usually result from lesions affecting the dorsal and the ventral streams. Damage to the main dorsal pathway is related to deficits in verbal repetition and fluency, while lesions affecting the ventral pathway are related to comprehension deficits. Thus, we propose that ME may emerge from spared dorsal stream when the ventral system is compromised, while CdA may result as an attemp of the ventral stream to compensate dorsal damage. In this study we analysed three cases of aphasia at linguistic and structural (MRI and PET) levels. In patient 1, speech was predominantly characterized by instances of CdA, patient 2 presented predominantly ME instances, and patient 3 had both CdA and ME. Results showed that patient 1 had a disconnection pattern that greatly overlapped with the dorsal language pathway, while patient 2 ́s lesion location bisected the ventral pathway discontinuing the projection of fibers that run through it. Patient 3 presented a disconnection pattern in-between the two previous ones. These findings suggest that symptoms as CdA and ME, that frequently appear in the chronic stage of aphasia may represent the behavioral expression of plastic changes occurring within the preserved language network in an attempt to compensate the linguistic functions associated to the damaged pathway. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Background: Approximately, 38% of stroke survivors develop a language disorder known as aphasia. Aphasia can affect each language differentially and can lead to different language recovery patterns...

To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.

In the past decades, neuroscientists and clinicians have collected a considerable amount of data and drastically increased our knowledge about the mapping of language in the brain. The emerging picture from the accumulated knowledge is that there are complex and combinatorial relationships between language functions and anatomical brain regions. Understanding the underlying principles of this complex mapping is of paramount importance for the identification of the brain signature of language and Neuro-Clinical signatures that explain language impairments and predict language recovery after stroke. We review recent attempts to addresses this question of language-brain mapping. We introduce the different concepts of mapping (from diffeomorphic one-to-one mapping to many-to-many mapping). We build those different forms of mapping to derive a theoretical framework where the current principles of brain architectures including redundancy, degeneracy, pluri-potentiality and bow-tie network are described.

It has long been assumed that the language function is hierarchically organized into specific cortical areas. Here, for the first time, we present direct evidence that the spinal cord takes part in language processing. In a randomized-double blind design, sixteen aphasics underwent a language treatment combined with transcutaneous spinal direct current stimulation (tsDCS). During the treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (IX-X vertebrae) in two different conditions: (1) anodal, and (2) sham while performing a verb naming task. Each experimental condition was run in five consecutive daily sessions over two weeks. Before and after each condition, all patients underwent a resting state functional magnetic resonance imaging (rs-fMRI). After anodal tsDCS, significant functional connectivity changes were found in a cerebellar-cortical network recruiting regions such as the left cerebellum, the right parietal and premotor cortex known to be also involved in action-related verb processing. Indeed, this increase of connectivity significantly correlated with the greatest amount of improvement found in verb naming. In line with our experimental data, we also found a greater improvement after anodal tsDCS also on untreated items of the language test but only on tasks which required the use of verbs, such as verb naming and picture description. No significant changes were found in noun naming. Thus, this evidence emphasizes, for the first time, that the neural response due to tsDCS combined with language treatment changes during the course of recovery by enhancing activity into cortical regions which influence verb processing.

The field of neuroanatomy of language is moving forward at a fast pace. This progression is partially due to the development of diffusion tractography, which has been used to describe white matter connections in the living human brain. For the field of neurolinguistics, this advancement is timely and important for two reasons. First, it allows clinical researchers to liberate themselves from neuroanatomical models of language derived from animal studies. Second, for the first time, it offers the possibility of testing network correlates of neurolinguistic models directly in the human brain. This chapter introduces the reader to general principles of diffusion imaging and tractography. Examples of its applications to normal language and its disorders will be used to explicate its potentials and limitations.

Supplemental Digital Content is available in the text., Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (

When thinking about what drives language recovery in aphasia, it is important to consider the possible role of attention processing. Not only is attention a fundamental skill that is required during even very simple tasks, it has also been shown to be impaired in individuals with aphasia. In this paper, we consider what successful attention during a typical language therapy session might look like, and discuss how impaired attention might negatively impact language treatment and recovery.

This chapter argues that successful language recovery evolves over time through a series of stages characterized by distinct paradigms (sets of assumptions), each of which in turn challenges deep-rooted assumptions of the preceding stage. The exposition draws on the narratives of Basque and Nawat language recovery to illustrate this, focusing on paradigm transitions which question typical priorities of orthodox approaches, such as the language’s oral character, its purity, native speakers, descriptivism, teaching children, and bonds with the rural world and a traditional lifestyle. A successful recovery process should transcend these constraints. It should recognize the importance of writing, neologisms, new speakers, prescriptive proposals, adult learners, urban settings and ideological neutrality. This alternative paradigm justifies current developments in the Nawat movement powered by the internet, social media, incorporation of new adult speakers, and a new generation of young, university-educated language enthusiasts.

Introduction: Aphasia is an acquired language injury apart from cognitive, motor, or sensory damages, as the result of a brain injury and stroke in the left hemisphere. In the acute phase of aphasia (the first two or three months) a preponderance of people show certain degrees of recovery, the neural mechanisms of which are yet to be detected, other than the fact that it is related to the plasticity changes in the patient’s brain. Neuroplasticity is the capacity of a brain to change or be modified at cellular or behavioral levels. Objectives: The current study aimed at reviewing the literature on neuroplasticity and factors affecting language recovery of patients with aphasia. Data Sources: PubMed, Google Scholar, ScienceDirect, Irandoc, Magiran, SID, Web of Knowledge, Ovid, Springer, and manual search of reference lists from January 1990 to April 2017. Inclusion Criteria: Neuroplasticity and aphasia keywords in the title of the article, studies conducted only on human samples, and adult samples with acquired aphasia. Results: Out of the 6637 retrieved studies, eight articles met the inclusion and exclusion criteria and two related papers were further reported. Recent studies show that three types of changes, in the nervous activity following stroke are closely related to aphasia recovery: reactivation of the injured areas of the left hemisphere or perilesional left hemisphere regions regarding language assignments, the ability to process language in the right hemisphere, and compensatory activity of the right hemisphere, which can hinder language recovery. Conclusions: Most studies demonstrated that areas around the left hemisphere lesion engage in the recovery of the language; certain studies, on the other hand, reported that areas around the right hemisphere are involved, and some consider both hemispheres to be involved in the language recovery. It is difficult to predict the improvement of language owing to the involvement of various factors. Limitations: One of the most important limitations was the unavailability of the full-text of three articles.

Background: Post-stroke loss and recovery of language functions evolves in time and space. A high functional dynamic can be observed in the first days and weeks after stroke, which has been associated with reorganisation processes in the left-lateralised language network, its right-hemisphere homologues and in the vicinity of the lesion site. With the advances in in vivo neuroimaging techniques, mapping changes in the language network over time (e.g., lesion extent, structural integrity of grey or white matter, task-based activity, functional or structural connectivity) is currently the focus of ongoing investigations.Main Contribution: This review highlights the recent findings on the neurobiology of language recovery from the hyperacute to the subacute phase after stroke. It relates pathophysiological processes of stroke evolution and the spatio-temporal characteristics of recovery patterns within the anatomically distributed language network to the behavioural dynamics of early language recovery.Conclu...

Predicting functional outcome in stroke is challenging to most clinicians, partly because of the complexity of the condition and also because of the lack of validated prognostic models. The strongest predictors of functional outcome are age and motor function at stroke onset. There is a growing literature on predicting recovery of upper limb after stroke; however, literature on prediction of language recovery remains sparse. This review covers the current status of predicting functional outcome after stroke focusing on recovery of activities of daily living, ambulation, upper limb use, and aphasia. Use of clinical factors, imaging, and neurophysiological measures are discussed.

Background: The role of the right hemisphere (RH) in the recovery of language is quite controversial.Aims: The aim of the present survey consisted in taking into account three main models advanced to explain the reconstitution of language systems: (1) the “perilesional hypothesis,” which maintains that language recovery is mainly subsumed by left hemisphere (LH) tissue adjacent to the lesion; (2) the “right hemisphere hypothesis,” which assumes that restitution of language entails an increased participation of the RH; and (3) the “disinhibition hypothesis,” which maintains that recovery is facilitated by disruption of inhibitions exerted by RH regions over LH language areas.Methods & Procedures: The prognostic factors in poststroke aphasia are discussed first, focusing attention on factors that could subsume an increased participation of the RH to the recovery of language. Then results obtained with techniques of noninvasive brain stimulations of the RH are taken critically into account.Outcomes & Results...

OBJECTIVE Currently, it is unclear whether a radical-by-radical (RBR) reading strategy exists in Chinese pure alexia, compared to the letter-by-letter (LBL) reading strategy in alphabetic languages. In this study, we focus on exploring the reading features of a Chinese pure alexic patient during the process of language recovery. METHOD We investigated this issue using a series of neuropsychological tests at 4 days, 11 days, and 8 months after admission of a Chinese pure alexic patient. RESULTS The results showed that most words could not be read aloud initially by the patient. One week later, 2 clinical features were noted: RBR reading strategy and integration impairment. Finally, there were statistically significant differences in the reaction time between the single characters and compound characters, which indicated that a radical number effect may exist. CONCLUSION Combined with the results of previous studies, the current case study indicates that there is evidence suggesting that the RBR reading strategy in Chinese pure alexia is of limited benefit, a result that appears fundamentally different from the LBL reading strategy.

Background Noninvasive transcranial stimulation methods have been increasingly employed in order to improve cognitive performance in neurological patients. In previous studies with both stroke patients and healthy subjects, noninvasive stimulation of temporal-parietal regions and their homologue produced an improvement in linguistic tasks. Objective The aim of the current study was to evaluate if anodal transcranial direct current stimulation (tDCS) over Brodmann areas 39/40 (angular and supramarginal gyri) could promote the recovery of linguistic functions, in particular comprehension and naming, in a single patient affected by dementia. Methods Three preliminary explorative single sessions (right-side anodal, left-side anodal and sham tDCS) were carried out (Experiment 1). This procedure allows targeting the more effective site of stimulation for the treatment. Subsequently, we carried out a five-days tDCS treatment on the selected hemisphere (Experiment 2). Results We report verb comprehension amelioration after 5 days of anodal tDCS over the right BAs 39/40 compared with the placebo tDCS. This result is maintained until two weeks after the end of the 5-days treatment. Conclusions Our findings provide new evidence for the therapeutic use of tDCS in degenerative diseases, suggesting that an explorative study can be useful for targeting the more appropriate stimulation site, and confirm the involvement of right-sided areas associated with language activities.

In the past few years, noninvasive cerebral stimulations have been used to modulate language task performance in healthy and aphasic patients. In this study, a dual transcranial direct current stimulation (tDCS) on anterior and posterior language areas was applied for 2 weeks to a patient with a possible crossed aphasia following a right hemisphere stroke. Inhibitory cathodal stimulation of the right Brodmann areas (BA) 44/45 and simultaneous anodal stimulation of the left BA 44/45 improved the patient’s performance in picture naming. Conversely, the same bilateral montage on BA 39/40 did not produce any significant improvement; finally, electrode polarity inversion over BA 39/40 yielded a further improvement compared with the first anterior stimulation. Our findings suggest that ipsilesional and contralesional areas could be useful in poststroke functional reorganization and provide new evidences for the therapeutic value of tDCS in aphasia.

Several studies have shown that transcranial direct current stimulation (tDCS) is a useful tool to enhance language recovery in aphasia. It has also been suggested that modulation of the neurotrophin brain-derived neurotrophic factor (BDNF) might be part of the mechanisms involved in tDCS effects on synaptic connectivity. However, all language studies have previously investigated the effects using unihemispheric stimulation. The purpose of the present study is to investigate the role of bihemispheric tDCS on language recovery and BDNF serum levels.Seven aphasic persons underwent an intensive language therapy in two different conditions: real bihemispheric stimulation over the left and right Broca's areas and a sham condition.After the stimulation, patients exibited a significant recovery in three language tasks (picture description, noun and verb naming) compared to the sham condition which persisted in the follow-up session. No significant differences were found in BDNF serum levels after tDCS stimulation and in the follow-up session. However, a significant positive correlation was present for the real stimulation condition between percent changes in BDNF levels and in the verb naming task.The data suggest that this novel approach may potentiate the recovery of language in chronic aphasia. They also emphasize the importance to further investigate the role of possible biomarkers associated with tDCS treatment response in language recovery.

Objective: Constraint induced aphasia therapy (CIAT) is a more intensive form of language treatment for aphasia as compared to traditional treatments. This study examined whether there are differences in cortisol stress levels between the two methods of aphasia treatment as well as effects on language skills. Design: Randomized controlled trial. Methods: A total of 20 participants with expressive aphasia were randomly placed into one of the two treatment groups. The CIAT group received 10 days of intensive treatment over two weeks. The traditional therapy group received 6 days of treatment over 2 weeks. All participants in each group provided salivary cortisol samples before treatment, at the mid-point of treatment, and at the conclusion of treatment. Language skills were assessed before treatment and at the conclusion of treatment. Results: A significantly higher proportion of individuals in the CIAT treatment group had increased salivary cortisol stress levels when compared to the traditional treatment group at the mid-point of the program (80% versus 30% respectively, p

Verbal stimuli often induce right‐hemispheric activation in patients with aphasia after left‐hemispheric stroke. This right‐hemispheric activation is commonly attributed to functional reorganization within the language system. Yet previous evidence suggests that functional activation in right‐hemispheric homologues of classic left‐hemispheric language areas may partly be due to processing nonlinguistic perceptual features of verbal stimuli. We used functional MRI (fMRI) to clarify the role of the right hemisphere in the perception of nonlinguistic word features in healthy individuals. Participants made perceptual, semantic, or phonological decisions on the same set of auditorily and visually presented word stimuli. Perceptual decisions required judgements about stimulus‐inherent changes in font size (visual modality) or fundamental frequency contour (auditory modality). The semantic judgement required subjects to decide whether a stimulus is natural or man‐made; the phonologic decision required a decision on whether a stimulus contains two or three syllables. Compared to phonologic or semantic decision, nonlinguistic perceptual decisions resulted in a stronger right‐hemispheric activation. Specifically, the right inferior frontal gyrus (IFG), an area previously suggested to support language recovery after left‐hemispheric stroke, displayed modality‐independent activation during perceptual processing of word stimuli. Our findings indicate that activation of the right hemisphere during language tasks may, in some instances, be driven by a “nonlinguistic perceptual processing” mode that focuses on nonlinguistic word features. This raises the possibility that stronger activation of right inferior frontal areas during language tasks in aphasic patients with left‐hemispheric stroke may at least partially reflect increased attentional focus on nonlinguistic perceptual aspects of language. Hum Brain Mapp, 2013. © 2012 Wiley Periodicals, Inc.

Background: While border-zone infarcts (BZI) account for about 10% of strokes, studies on related aphasia are infrequent. The aim of this work was to redefine specifically their early clinical pattern and evolution. Methods: We prospectively studied consecutive patients referred to our stroke unit within a 2-year period. Cases of aphasia in right-handed patients associated with a MRI confirmed left-sided hemispheric BZI were included. These patients had a standardized language examination in the first 48 h, at discharge from stroke unit and between 6 and 18 months later. Results: Eight patients were included. Three had anterior (MCA/ACA), two posterior (MCA/PCA), two both anterior and posterior, and one bilateral BZI. All our patients initially presented transcortical mixed aphasia, characterized by comprehension and naming difficulties associated with preserved repetition. In all patients, aphasia rapidly improved. It fully recovered within a few days in three patients. Initial improvement was marked, although incomplete in the five remaining patients: their aphasias specifically evolved according to the stroke location toward transcortical motor aphasia for the three patients with anterior BZI and transcortical sensory aphasia for the two patients with posterior BZI. All patients made a full language recovery within 18 months after stroke. Conclusions: We report a specific aphasic pattern associated with hemispheric BZI, including an excellent long-term outcome. These findings appear relevant to (i) clinically suspect BZI and (ii) plan rehabilitation and inform the patient and his family of likelihood of full language recovery.

An important proposal in the insightful Keynote Article by Baum and Titone is that the field of bilingualism research needs to attend more closely to intersubject variability in order to understand the nature of neuroplastic changes in the brains of bilingual speakers as they age. I agree. Understanding such variability and its drivers (such as the contexts of language use that Baum and Titone nicely comment on in the Montreal milieu) will help us develop theoretical accounts of the cognitive control processes recruited in bilingual speakers and establish how adaptive changes to these processes mediate the effects of normal aging; yield protective effects against neurodegenerative disease, such as Alzheimer disease; and modulate language recovery poststroke in bilingual speakers. In this commentary I explore some aspects of this variability and commend, in line with the views expressed in the Keynote Article, the value of relating behavioral indices to whole brain structural magnetic resonance imaging for enriching our understanding of experience-dependent changes. Allied to tractography studies, such research can help us develop a rich picture of the major drivers of neuroplastic changes.

For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients' fluency, but it was not until 1973 that a music-based treatment [Melodic Intonation Therapy (MIT)] was developed. Our ongoing investigation of MIT's efficacy has provided valuable insight into this therapy's effect on language recovery. Here we share those observations, our additions to the protocol that aim to enhance MIT's benefit, and the rationale that supports them.

The present case study aims to investigate whether the treatment of a third language (L3 French) in a trilingual chronic Wernicke-aphasic patient leads to the parallel improvement of the first (L1 German) and second (L2 English) languages. After a linguistic assessment in each language by means of the Bilingual Aphasia Test (BAT) [Paradis, M. (1987). The assessment of bilingual aphasia . Hillsdale: Lawrence Erlbaum], the patient was intensively treated in his L3 twice a day for 45 min for three and a half weeks. The treatment focussed on lexical–semantic deficits. Subsequent to the treatment, the patient was tested again in the three languages. The resulting recovery pattern shows that both L2 and L3 significantly improved after treatment with a larger effect for the treated language (L3) than for the L2. In contrast, L1 (German) did not show significant improvement, probably because the test results were already above-average for the first testing (T1). The present findings lend support to cognitive models of bilingual word recognition postulating that a bilingual's two languages share a common semantic–conceptual memory system.

Background: The reacquisition of language after stroke may profit from intense training with several hours of language exercises provided on each training day, especially in the chronic stage. Despite the general effectiveness of this, few studies to date have examined which brain regions mediate successful language recovery as a result of intense training. This knowledge is particularly important because the necessity of several hours of language exercises each day draws a considerable amount of (a) attentional and cognitive resources from the patients and (b) financial and personnel resources from the health system. Aims: Not all aphasia patients may be equally suited for intense training approaches. Functional imaging studies of treatment‐induced recovery in chronic aphasia may provide answers to this question and may allow the target‐oriented allocation of aphasia patients to (intense) training in the future. In the following sections we will provide a comprehensive review of functional imaging studie...

Background: Predicting aphasia recovery after stroke has been difficult due to substantial variability in outcomes. Few studies have characterised the nature and extent of recovery, beginning with baselines at 24–72 hours after stroke onset. Aim: To characterise the course of language recovery after first-time stroke. Methods: Using our Performance and Recovery in Stroke Study (PARIS) database, we evaluated consecutive first-time stroke patients with aphasia and diffusion-weighted-image-positive lesions on admission and at 90 days. Results: Twenty-two of 91 patients had language disorders. Initial syndrome scores were positively correlated with 90-day scores (r = 0.60) and negatively correlated with the change in score from baseline to follow-up (r = −0.66). Neither lesion size, age nor education correlated with initial syndrome severity or with performance at 90 days. Level of education was not associated with degree of recovery. A multiple regression model that combined lesion size, age and initial syndrome was significant (p = 0.03) but only explained 29% of the variance. Patients with severe deficits at baseline in individual language domains could recover, improve to a less severe deficit or not improve at all. Conclusion: There was significant variability in language recovery after first-time stroke, even in more severe, initial syndromes. Traditional predictors of post-stroke language outcomes did not reliably predict function at 90 days. These data suggest that other factors that account for functional stroke recovery have not yet been identified.

This essay considers a production of Shakespeare’s Macbeth, produced by Alaska’s Perseverance Theatre at the Smithsonian National Museum of the American Indian in March 2007, in which the construction of a new cultural product—a Macbeth translated into the social and linguistic setting of a pre-contact Tlingit society—was claimed as part of a process of language revitalization for the endangered Tlingit language. Perseverance’s Macbeth demonstrated that language recovery might be attainable through importing an iconic text from an hegemonic language and culture and claiming it for the threatened language. At the same time, Perseverance had to confront the possibility that their project could be viewed as a colonizing activity. This inquiry examines several translational tactics the production employed, with the goal of considering the project as one potential methodology for generating linguistic life for an endangered language and reversing language shift. In addition, the study considers how translational comparison at the cultural level demonstrates how the Tlingit Macbeth operated as a two-way force in cultural creation, informing the source as much as the target.

Purpose The purpose of this article is to review the behavioral treatments used in aphasia rehabilitation research that have been combined with transcranial direct current stimulation (tDCS). Although tDCS in aphasia treatment has shown promise, the results have not been conclusive, and their interpretation is further compounded by the heterogeneity of study characteristics. Because implementing a behavioral task during brain stimulation has been shown to be pivotal to the adjuvant effects of tDCS, we analyze the behavioral treatments that have been paired with tDCS. Method A computerized database search (PubMed) was completed to document and review aphasia treatment studies that combine behavioral treatment with noninvasive brain stimulation in the form of tDCS. Two authors reviewed each aphasia tDCS article published between 2008 and 2015 and evaluated (a) the behavioral interventions for aphasia that have been combined with tDCS, and (b) the methodological variables that may have influenced language outcomes in the tDCS aphasia literature. Conclusions A review of the behavioral treatments implemented in tDCS aphasia rehabilitation studies highlights several methodological considerations for future investigations. Impairment-focused and pragmatic treatments have been implemented in tDCS aphasia research studies. No one behavioral approach stands out as the best treatment to combine with tDCS for the promotion of language recovery.

Considering the high incidence of poststroke aphasia and its significant economic impact on the society, there is a pressing need to understand the basic mechanisms of language recovery. Over the recent years, several prognosis models for predicting aphasia outcome have been proposed. In this article, we review models based on neuroimaging methods that have a direct impact on both clinical neuroscience and patient care.

This paper explores the process of language recovery in an English-Spanish bilingual six year old child. One of the first languages of the child had become passive, that is she was able to understand what was said to her in Spanish but she was no longer able to speak it. On a subsequent visit to a Spanish-speaking country data were gathered to piece together the process of her recovery of the production abilities in the language. This paper documents the rapid process of recovery that took place and, based on these results, considers the value of maintaining 'passive bilingualism' in children and examines the strategy employed by the family to achieve this. The paper contributes to the study of the language development of the bilingual and documents language change in progress. It also provides a positive alternative approach to maintaining bilingualism in children in contrast to the more 'strict/purist' line advocated in the literature on bilingualism.

Grafman, in this issue, discusses four forms of neuroplasticity that may account for development and recovery of functional neural networks in the human brain. These include homologous area adaptation, cross-modal reassignment, map extension, and compensatory masquerade. The following discussion focuses on these forms of neuroplasticity as they pertain to recovery of language function in aphasia. The first part of the paper presents data showing that two of the four forms, homologous area adaptation and map extension, are relevant to recovery from aphasia. The second part of the paper discusses factors related to neuroplastic activity during language recovery, including neurophysiological, subject, and environmental, that is, treatment variables. Data from animal studies as well as recent data from aphasia treatment studies will provide a basis for this discussion.

Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential therapeutic tool for the rehabilitation of language in chronic non-fluent aphasia post-stroke. Previous studies report that low frequency (1 Hz) rTMS applied to homologous language sites can facilitate behavioural language changes. Improvements in picture naming performance and speech output are frequently reported.This study aims to assess the efficacy of inhibitory rTMS to modulate language performance in non-fluent aphasia.Low-frequency (1 Hz) rTMS was applied to six active stimulation and six placebo patients for 20 min per day over 10 days, as outlined in a previous published investigation. Behavioural language outcome measures were taken at baseline (pre-stimulation) and 1 week, 2 months, 8 months and 12 months post-stimulation.The findings demonstrate treatment-related changes observed in the stimulation group, up to 12 months post-stimulation, when compared to the placebo control group over time for naming performance, expressive language and auditory comprehension.These outcomes provide considerable evidence to support the theory of rTMS modulating mechanisms of transcallosal disinhibition in the aphasic brain, and highlight the potential clinical application of rTMS for language rehabilitation in chronic aphasia.

The design of functional neuroimaging studies investigating the neural changes that support treatment-based recovery of targeted language functions in acquired aphasia faces a number of challenges. In this paper, we discuss these challenges and focus on experimental tasks and experimental designs that can be used to address the challenges, facilitate the interpretation of results and promote integration of findings across studies. (C) 2012 Elsevier Inc. All rights reserved.

We have assessed 26 aphasic patients, matched in pairs as closely as possible for personal data (age, sex, education), neurological damage suffered (nature, site and size of lesions) and characteristics of linguistic impairments (type of aphasic syndrome and severity of aphasia). These patients were therefore distinguishable only by the presence (n=13) or absence (n=13) of structured, systematic language therapy. The assignment to one group or the other was not random; rather, the patients who constitute the non-rehabilitated group could not, for logistic and/or familial reasons, attend language therapy sessions. Our findings confirm the effectiveness of language rehabilitation in aphasic disorders: at the end of 6 months of therapy the number of patients who met our criterion for improvement was significantly higher in the treated group in the expressive language modality. The rehabilitated and non-rehabilitated groups did not differ significantly at 4 months post-onset, while they did differ si...