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

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.

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, and 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.