Enhancing Reading Rehabilitation in Subacute Stroke Using fMRI Neurofeedback.
Poster No:
1030
Submission Type:
Abstract Submission
Authors:
Olga Boukrina1, Yekyung Kong2, Pranav Reddy1, Guang Yue1, Yury Koush3
Institutions:
1Kessler Foundation, West Orange, NJ, USA, 2Kessler Institute for Rehabilitation, West Orange, NJ, USA, 3Skolkovo Institute of Technology, Moscow, Russian Federation
First Author:
Co-Author(s):
Introduction:
Each year, 21-38% of the 13.7 million stroke survivors worldwide experience reading impairments as a result of an acquired communication disorder called aphasia(1–4). For more than half of persons with aphasia, reading and language impairments become a chronic condition(5), preventing them from maintaining independent living, accessing information, and pursuing education or career opportunities. This means that a large proportion of stroke survivors with reading impairments have an incomplete response to rehabilitation. There is an urgent need for effective early interventions that can improve this statistic.
We developed and tested a novel neurobehavioral reading intervention using fMRI neurofeedback (NFB). Stroke participants were given real-time NFB about their ongoing brain activity to help them in developing brain regulation strategies. We hypothesized that using NFB can increase neural activation of the affected neural circuits and thereby improve recovery of reading abilities.
We developed and tested a novel neurobehavioral reading intervention using fMRI neurofeedback (NFB). Stroke participants were given real-time NFB about their ongoing brain activity to help them in developing brain regulation strategies. We hypothesized that using NFB can increase neural activation of the affected neural circuits and thereby improve recovery of reading abilities.
Methods:
Four individuals with subacute left hemisphere stroke (M age=63.5, SD=17, all men, M days post stroke =21.3, SD = 5.8, WAB(6) Aphasia Quotient (AQ)=73.38, SD=31.11) and 3 age-matched healthy controls (HCs) (M age=66, SD=6, all men) participated in the study. Participants underwent 3 NFB training scans, spaced one week apart, consisting of two 15-min runs. During the intervals between scans, they completed 10 30-min homework sessions to practice the strategies learned during NFB training. We measured the NFB signal, reading accuracy, reading comprehension using the RCBA(7), and aphasia severity using the WAB before and after training.
During NFB training(8), participants imagined right hand finger movements, e.g. typing on a keyboard, tracing letters in a book, tapping on piano keys, or tapping each finger in sequence. Our goal was to activate the left Supramarginal Gyrus (SMG), known to support letter-to-sound conversion(9,10), as well as kinesthetic motor imagery and planning of finger movements(11,12). After the motor imagery block participants read aloud real and novel words (8 words presented for 1s+2s response period, jittered). The NFB signal was computed as the difference between the imagine and read blocks relative to a fixation baseline, scaled to 0-100. The sequence of blocks (baseline (21s), imagine (21s), read (24s)) was repeated 9 times per run and participants received intermittent feedback after each repeat.
During NFB training(8), participants imagined right hand finger movements, e.g. typing on a keyboard, tracing letters in a book, tapping on piano keys, or tapping each finger in sequence. Our goal was to activate the left Supramarginal Gyrus (SMG), known to support letter-to-sound conversion(9,10), as well as kinesthetic motor imagery and planning of finger movements(11,12). After the motor imagery block participants read aloud real and novel words (8 words presented for 1s+2s response period, jittered). The NFB signal was computed as the difference between the imagine and read blocks relative to a fixation baseline, scaled to 0-100. The sequence of blocks (baseline (21s), imagine (21s), read (24s)) was repeated 9 times per run and participants received intermittent feedback after each repeat.
Results:
Two of 3 HCs and 3 of 4 patients showed increased NFB signal post- compared to pre-training, as measured using transfer runs without overt feedback to participants (Pre: M HC =41.39,SD=51.16; M Patients=7.07,SD=10.20; Post: M HC=63.63,SD=47.13, M Patients=8.24,SD=13.09). This indicates that following training activity in the left SMG increased during imagine and read blocks relative to baseline (Fig.1). Among stroke patients, reading accuracy increased by 4.5% (SD=6.4) for real words and by 13% (SD=10.42) for pseudowords. WAB AQ increased by 5.48 points (SD=4.25), indicating a clinically significant reduction in the overall aphasia severity. RCBA scores increased by 9.75 points (SD=6.29), indicating improved reading comprehension. Overall, participants rated their motivation and commitment to participate in the NFB training as high to very high, and the difficulty of the training as somewhat easy to neutral.
Conclusions:
To date, only 5 fMRI NFB stroke rehabilitation studies, including 2 on aphasia with 2-8 stroke participants each, have been published. Our study contributes to this limited body of research by showing the feasibility and potential of fMRI NFB in post-stroke reading rehabilitation. However, our initial results, limited by a male-only sample and the possibility of spontaneous recovery, should be interpreted cautiously. More robust conclusions await future studies incorporating a sham NFB control group. This research marks a preliminary step in developing biologically-informed interventions for reading deficits in aphasia.
Language:
Reading and Writing 1
Learning and Memory:
Neural Plasticity and Recovery of Function 2
Keywords:
Aphasia
Language
MRI
Other - real time fMRI neurfeedback, stroke, reading deficits
1|2Indicates the priority used for review
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