Targeted Reading Treatment Combined with Aerobic Exercise Improves Aphasia Outcomes.
Poster No:
1025
Submission Type:
Abstract Submission
Authors:
Olga Boukrina1, Abubakar Yamin2, Brian Sandroff1, Elizabeth Madden3, Yekyung Kong4, William Graves5
Institutions:
1Kessler Foundation, West Orange, NJ, USA, NJ, 2Rutgers New Jersey Medical School, Newark, NJ, 3Florida State University, Tallahassee , FL, 4Kessler Institute for Rehabilitation, West Orange, NJ, 5Rutgers, The State University of New Jersey, Newark, NJ
First Author:
Co-Author(s):
Introduction:
An estimated 30% of stroke survivors worldwide experience aphasia(1,2), an acquired communication disorder, affecting multiple aspects of language, such as speaking, understanding, reading and writing(3). Reading deficits in aphasia are common and severely limit one's autonomy and quality of life(2,4). Our research aims to fill the gap in the current treatment approaches by focusing on cognitive and neural processes critical to reading. The study tested a personalized targeted intervention combining the beneficial impact of aerobic exercise training (AET) with an intensive phono-motor reading treatment (PMT)(5) aimed at rebuilding and strengthening damaged phonological neural networks involved in reading.
Multiple studies have shown that cerebral blood flow (CBF) is decreased in the left hemisphere for weeks to months following stroke in areas that are not directly affected by an obvious structural lesion and this is correlated with language and reading impairments (6–8). We tested the hypothesis that regular aerobic exercise improves brain circulation and promotes the acquisition, retention, and generalization of skills learned during reading therapy.
Multiple studies have shown that cerebral blood flow (CBF) is decreased in the left hemisphere for weeks to months following stroke in areas that are not directly affected by an obvious structural lesion and this is correlated with language and reading impairments (6–8). We tested the hypothesis that regular aerobic exercise improves brain circulation and promotes the acquisition, retention, and generalization of skills learned during reading therapy.
Methods:
Seven individuals with chronic post-stroke aphasia (M age=57.8, SD=11.7, 2 women) participated in the study. Four participants completed 60 hours of PMT alone, while 3 participants received 22-60 hours of PMT preceded by 20 min of AET (stationary cycling at 60% heart rate range) and 10 min warm-up and cool-down. Treatment was delivered to both groups 5x/week for 2 hours/session. We assessed language and reading outcomes before and after the intervention and collected perfusion MRI data in the AET+PMT participants before, after 1 AET session, and after treatment. We also recorded fMRI brain activity during a reading task and at rest before and after treatment.
Results:
Among participants who received combined AET+PMT, reading aloud accuracy improved by 15% (SD=14%, Cohen's d=0.70, medium effect size (ES)) for real words and by 25% (SD=25%, Cohen's d=.77, large ES) for novel nonwords. Nonwords measure participants' flexibility in converting letters into corresponding sounds and are especially difficult for participants with aphasia. Western Aphasia Battery(9) aphasia quotient (AQ) increased by an average of 6.4 points (SD=0.88), indicating a clinically significant improvement in aphasia severity(10). The PMT-only group improved by 5% (SD=7%, Cohen's d=.11, small ES) in word reading and by 22% (SD=17%, Cohen's d=.62, medium ES) in nonword reading. Only 2 out of 4 PMT-only participants showed improved WAB-AQ (M change=3.6, SD=0.35).
For 2 AET+PMT participants who completed the full treatment (60h of PMT+20h of AET), global CBF increased, indicating that more oxygen and nutrients were delivered to the brain (see Fig.1). Dynamic resting state functional connectivity increased between visual and auditory and dorsal and ventral frontoparietal networks bilaterally (Fig.2). For the reading aloud fMRI task, we de-coupled brief word/nonword presentation from periods of overt speech. Following AET+PMT, activation during word/nonword viewing increased significantly in the right anterior temporal lobe, frontal pole, subcallosal cortex, posterior superior temporal gyrus, and bilateral lateral occipital cortex. Activation during speech periods increased in the left Heschl's gyrus (primary auditory cortex) and left sensorimotor cortex corresponding to face and hand areas.
For 2 AET+PMT participants who completed the full treatment (60h of PMT+20h of AET), global CBF increased, indicating that more oxygen and nutrients were delivered to the brain (see Fig.1). Dynamic resting state functional connectivity increased between visual and auditory and dorsal and ventral frontoparietal networks bilaterally (Fig.2). For the reading aloud fMRI task, we de-coupled brief word/nonword presentation from periods of overt speech. Following AET+PMT, activation during word/nonword viewing increased significantly in the right anterior temporal lobe, frontal pole, subcallosal cortex, posterior superior temporal gyrus, and bilateral lateral occipital cortex. Activation during speech periods increased in the left Heschl's gyrus (primary auditory cortex) and left sensorimotor cortex corresponding to face and hand areas.
Conclusions:
Incorporating aerobic exercise into a targeted reading intervention led to a 19% improvement enhancement in nonword and 220% in word reading accuracy compared to reading therapy alone and resulted in greater overall improvement of aphasia severity. Neuroimaging data suggested that these gains were supported by increased global cerebral circulation, bilateral brain activation and dynamic functional connectivity. This study offers crucial early empirical evidence supporting the integration of AET with cognitive rehabilitation strategies.
Language:
Reading and Writing 1
Novel Imaging Acquisition Methods:
Multi-Modal Imaging 2
Keywords:
Language
Therapy
Other - stroke, rehabilitation, reading, exercise
1|2Indicates the priority used for review
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