Finding the right words: predicting, and treating, spoken language production deficits after aphasic stroke.

Lead Research Organisation: University College London
Department Name: Institute of Cognitive Neuroscience

Abstract

Being able to communicate is something most of us take for granted. Speaking, and finding the right words to express ourselves is a skill that we use everyday. But when a person has aphasia (acquired communication disorder) after a stroke these everyday communication skills become a source of profound frustration and anxiety both for the person with aphasia and their families. While some people do recover many don‘t The proposed research aims to understand why only some patients recover spoken language after stroke and for those who don‘t recover identify potential methods to help make treatment more effective. Much has to be learnt about how the brain connects speech and language and how the brain recovers after stroke. To illustrate the brain connections that are important for spoken language production I will use brain-imaging techniques with healthy populations and people with aphasia, some days, others years after their stroke. The benefit of understanding this brain connectivity is that it will allow researchers and clinicians to make specific testable predictions about how spoken language production and the organisation of the brain will be after aphasic stroke, and how we can try to rehabilitate it. The proposed research will test these predictions.

Technical Summary

Speaking, and finding the rights word to express ourselves is a skill that most of us use, and take for granted everyday. When a person has anomia (spoken word retrieval difficulties) after an aphasic stroke these everyday communication skills become a source of profound frustration and anxiety, both for the person with aphasia and for their families. While some people do recover many don‘t. The proposed research addresses this issue, using neuroimaging as a surrogate marker of brain function and spoken language production skills to guide predictions about recovery and target intervention in aphasic patients with anomia.
Surprisingly little is know about the neural basis of our spoken language ability. Although functional neuroimaging studies have highlighted which cortical brain regions are associated with various spoken language tasks they have not directly addressed the underlying neural connections necessary for efficient performance of these tasks. I will explicitly address this issue using a novel structural and functional connectivity approach to spoken language production. In 3 series of experiments I will:
Investigate functional and anatomical connectivity in the normal spoken language production system.
Characterize the lesion data in acute and chronic stroke patients to develop predictive models of spoken language production deficits post stroke,
Characterize the spoken language production deficits and relate this to brain structural and functional connectivity in aphasic stroke patients
Perform a proof of concept treatment study, assessing the effects of a computer delivered anomia intervention with (or without) facilitatory repetitive transcranial magnetic stimulation.
The results will have translational importance. Not only will it advance the neuroscientific understanding of spoken language production. It will also provide an empirical basis from which to investigate specific speech and language therapy interventions in clinical trials,nd provide a means of targeting which patients are likely to respond to specific therapies. This would greatly improve the quality of treatment for the estimated 250,000 people in the UK who have chronic aphasia after stroke.
 
Description Article focusing on my career in Bulletin Magazine for RCSLT
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Article focusing on our research in Bulletin Magazine for RCSLT
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical reviews
 
Description Patient report on our research in Bulletin Magazine for RCSLT - Aphasia and stroke research
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Citation in clinical reviews
 
Description Summer School on Aphasia Rehabilitation
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description contribution to the structure and content of Calman Pan Thames Neurology Spr Training days
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description contribution to the structure and content of MSc training courses at UCL : ongoing commitment
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Brain Travel Award
Amount £800 (GBP)
Organisation Guarantors of Brain 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2011 
End 06/2011
 
Description Case studentship
Amount £120,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 10/2016 
End 09/2020
 
Description Project grant
Amount £570,915 (GBP)
Funding ID MR/K022563/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 01/2013 
End 07/2016
 
Description Senior Clinical Fellowship
Amount £1,280,536 (GBP)
Funding ID 106161 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2016 
End 01/2021
 
Description iTALK
Amount £20,000 (GBP)
Organisation The Tavistock Trust for Aphasia 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2011 
End 06/2014
 
Description Finding the right words 
Organisation Johns Hopkins University
Country United States 
Sector Academic/University 
PI Contribution I spent 8 months in JHU working with Professor of Neurology. I conducted a short project - imaging patients with primary progressive aphasia. I collected the imaging data, set up new collaborations with JHU with methods group to improve image analyses. I showed JHU researchers how to analyse imaging data with UK methods (SPM). I assisted on many other projects on imaging data.
Collaborator Contribution Access to patients with PPA not available to me in UCL Training in acute stroke imaging Training in new methods for image analyses Data collection Peer reviewed publications Introduction to researchers in USA with similar interests
Impact Invited to workshop: Imaging aphasia September 2009- position statement series of publications to follow. Invited speaker: Academy of Aphasia October 2009. Imaging Spelling deficits in PPA ( data collected at JHU) 4 accepted papers in peer reviewed journals.
Start Year 2008
 
Title iTALK 
Description Current seed funding from Tavistock Trust for Aphasia - developed prototype Awarded MRC case studentship 2016 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Initial development
Year Development Stage Completed 2011
Development Status Under active development/distribution
Impact 2011 MRC Fellows' Symposium Winner of the inaugural Futurecasting competition 
 
Description 2 Articles in RCSLT Bulletin Magazine 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 2 articles focusing on my career as a clinical scientist and my research

Many national SLTs, have contacted me for clinical and career advice and/ or volunteering to take part in my research programme.
Higher than expected interest from postgraduate SLTs iin Neuroscience courses at UCL and volunteering in my lab
Year(s) Of Engagement Activity 2011
 
Description Aging well Interview( USA) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Brain Stimulation to Improve Speech After Stroke - Aging Well ...
www.agingwellmag.com/archive/070912p8.shtml

Public engagement and emails into taking part in research
Year(s) Of Engagement Activity 2012
 
Description Bangor University, April 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact 40 staff attended. Days meeting with staff and students

Postdoc student applied for a NIHR fellowship with time in my lab. Awaiting outcome.
Year(s) Of Engagement Activity 2012
 
Description Brussels, January 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact 60 staff and students and clinicans attended.

raised international profile of my group and work,
Year(s) Of Engagement Activity 2012
 
Description Film interview 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Worked with team creaing film of patients recoevery over a 1 year period. See trailer here :
http://vimeo.com/41346149
password: minilot

Invited guest to David Lynch Gala charity dinner ( Nov 2012) .
Funded by WEllcome Trust , interest from BBC to get further.
Year(s) Of Engagement Activity 2012
 
Description Guest writer for Aphasia Now charity 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Many international stroke patients, their carers, other stroke researchers have contacted me for clinical advice and/ or volunteering to take part in my research programme.

Higher than expected interest from stroke patients waiting to take part in research studies.
Year(s) Of Engagement Activity 2006,2007,2008,2009,2010
 
Description Hospital Lectures and Specialist Clinical Service. London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Over 30 clinicians attend annually including SLTS and neurologists working in neurology and rehabilitation.

I now provide a new outpatient SLT clinic at NHNN, UCLH to offer specialist SLT service for chronic stroke patients with aphasia . This will also offer support and training to clinical SLTS working with aphasic patients and easy access for patients and their carers to ongoing research programme that may benefit and/ or be on interest to them.
Year(s) Of Engagement Activity 2006,2007,2008,2009,2010
 
Description Observer article/interview (UK) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact http://www.guardian.co.uk/science/2012/jun/03/electrical-brain-stimulation-treatments

High number of patient and public emails - subjects from across UK including mainland Europe and America wanting to take part.
Year(s) Of Engagement Activity 2012
URL http://www.guardian.co.uk/science/2012/jun/03/electrical-brain-stimulation-treatments
 
Description Open minds article (USA) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Ran an article on my brain stimulation work for language recovery August 2012

OPEN MINDS Weekly News Wire is a nationally distributed, weekly market intelligence report that focuses on key developments and management issues affecting the behavioral health and social service industry. The 40,000 subscribers are executives of payer organizations, care delivery systems, and other stakeholders with an interest in service to complex consumers. The publisher, OPEN MINDS, is a national market intelligence and management consulting firm specializing in these areas of health and human services. For more information, please visit http://www.openminds.com.
Year(s) Of Engagement Activity 2012
 
Description Public lecture: Words as Words ( Selfridges, London UK) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Words as words: Lecture series in Selfridges, London, UK.


Impact:
Web review: http://www.itsnicethat.com/articles/words-as-words-dr-jenny-crinion
Video online: vimeo.com/41305744
Year(s) Of Engagement Activity 2012
URL http://www.itsnicethat.com/articles/words-as-words-dr-jenny-crinion
 
Description ScienceNews Publication 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Attended Cognitive Neuroscience conference, Chicago March 2012 gave a platform presentation there ( n=300 ) and then was interview by Science journalist.


A number of patient , public interest contacted me via email and continue to do so weekly.

It sparked some global posts online at ScienceNews, Neurocritic blogspot, MedicalXpress.com, NewsMedical, Newstrack India, NewKerala.com, Sante Log, and American Scientist.
Year(s) Of Engagement Activity 2012
 
Description TV interview (BBC) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact BBS series in progress - stroke recovery advice; also another on acquired communication problems

In progress . Good links with BBC.
Year(s) Of Engagement Activity 2012
 
Description University of San Diego, November 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 60 departmental staff attended talk. Have a days individual meetings with senior staff within neuroscience and psychology departments.

Future new collaborations.
Year(s) Of Engagement Activity 2012