Change in Right Inferior Longitudinal Fasciculus Integrity Is Associated With Naming Recovery in Subacute Poststroke Aphasia

Background. Despite progress made in understanding functional reorganization patterns underlying recovery in subacute aphasia, the relation between recovery and changes in white matter structure remains unclear. Objective. To investigate changes in dorsal and ventral language white matter tract integrity in relation to naming recovery in subacute poststroke aphasia. Methods. Ten participants with aphasia after left-hemisphere stroke underwent language testing and diffusion tensor imaging twice within 3 months post onset, with a 1-month interval between sessions. Deterministic tractography was used to bilaterally reconstruct the superior longitudinal fasciculus (SLF), inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), middle longitudinal fasciculus (MdLF), and uncinate fasciculus (UF). Per tract, the mean fractional anisotropy (FA) was extracted as a measure of microstructural integrity. Naming accuracy was assessed with the Boston Naming Test (BNT). Correlational analyses were performed to investigate the relationship between changes in FA values and change in BNT score. Results. A strong positive correlation was found between FA change in the right ILF within the ventral stream and change on the BNT (r = 0.91, P <.001). An increase in FA in the right ILF was associated with considerable improvement of naming accuracy (range BNT change score: 12-14), a reduction with limited improvement or slight deterioration. No significant correlations were found between change in naming accuracy and FA change in any of the other right or left ventral and dorsal language tracts. Conclusions. Naming recovery in subacute aphasia is associated with change in the integrity of the right ILF

Prediction of everyday verbal communicative ability of aphasic stroke patients after inpatient rehabilitation

Background: Early accurate prediction of verbal communicative ability at discharge from inpatient rehabilitation is essential for rehabilitation professionals to provide reliable prognostic information to the aphasic patient and family, and to make appropriate treatment decisions. Aims: To develop a prediction model for verbal communicative ability at discharge from inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at rehabilitation admission. Methods & Procedures: Eighty-four stroke patients with moderate-to-severe aphasia were selected from a cohort of aphasic patients who enrolled in an inpatient rehabilitation programme from September 2010 to September 2013. From a group of eight candidate prognostic factors (demographic, neurological, and language variables, and the ictus-to-admission interval), those significantly associated with verbal communication (Amsterdam–Nijmegen Everyday Language Test scale A) at discharge were selected by means of multiple linear regression analyses. Outcomes & Results: A prognostic model of verbal communication was constructed, including verbal communicative ability and the phonology score at admission as independent predictors, which explained 64% of the adjusted variance. The ictus-to-admission interval was a marginally significant predictor. Age, sex, stroke type, activities of daily living dependency, and semantics did not make significant contributions to the prediction model. Conclusions: The results of this study represent a first step in the development of a prediction model for verbal communication outcome after inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at admission. After the performance of the prognostic model has been externally validated, it can be used to inform patients with moderate-to-severe aphasia and their families about the expected recovery of verbal communicative ability after inpatient rehabilitation, and it may guide clinicians, patients, and their relatives in shared decisions on the most appropriate treatment approach to improve functional communication

Prediction of everyday verbal communicative ability of aphasic stroke patients after inpatient rehabilitation

Background: Early accurate prediction of verbal communicative ability at discharge from inpatient rehabilitation is essential for rehabilitation professionals to provide reliable prognostic information to the aphasic patient and family, and to make appropriate treatment decisions. Aims: To develop a prediction model for verbal communicative ability at discharge from inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at rehabilitation admission. Methods & Procedures: Eighty-four stroke patients with moderate-to-severe aphasia were selected from a cohort of aphasic patients who enrolled in an inpatient rehabilitation programme from September 2010 to September 2013. From a group of eight candidate prognostic factors (demographic, neurological, and language variables, and the ictus-to-admission interval), those significantly associated with verbal communication (Amsterdam–Nijmegen Everyday Language Test scale A) at discharge were selected by means of multiple linear regression analyses. Outcomes & Results: A prognostic model of verbal communication was constructed, including verbal communicative ability and the phonology score at admission as independent predictors, which explained 64% of the adjusted variance. The ictus-to-admission interval was a marginally significant predictor. Age, sex, stroke type, activities of daily living dependency, and semantics did not make significant contributions to the prediction model. Conclusions: The results of this study represent a first step in the development of a prediction model for verbal communication outcome after inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at admission. After the performance of the prognostic model has been externally validated, it can be used to inform patients with moderate-to-severe aphasia and their families about the expected recovery of verbal communicative ability after inpatient rehabilitation, and it may guide clinicians, patients, and their relatives in shared decisions on the most appropriate treatment approach to improve functional communication