Facilitation of Auditory Comprehension After Theta Burst Stimulation of Wernicke's Area in Stroke Patients: A Pilot Study

Since the effect is transitory you will need to have your doctor and stroke hospital followup with researchers to ensure research on how to make this permanent is done.

Facilitation of Auditory Comprehension After Theta Burst Stimulation of Wernicke's Area in Stroke Patients: A Pilot Study

Viviana Versace^1,2*, Kerstin Schwenker^3,4, Patrick B. Langthaler³, Stefan Golaszewski^3,4, Luca Sebastianelli^1,2, Francesco Brigo^5,6, Elke Pucks-Faes⁷, Leopold Saltuari^2,7 and Raffaele Nardone^3,4,5

• ¹Department of Neurorehabilitation, Hopsital of Vipiteno-Sterzing, Vipiteno-Sterzing, Italy
• ²Research Unit for Neurorehabilitation of South Tyrol, Bolzano, Italy
• ³Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
• ⁴Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
• ⁵Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
• ⁶Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
• ⁷Department of Neurology, Hochzirl Hospital, Zirl, Austria

Introduction: 

Single-pulse transcranial magnetic stimulation (TMS) and high-frequency repetitive TMS (rTMS) over Wernicke's area were found to facilitate language functions in right-handed healthy subjects. We aimed at investigating the effects of excitatory rTMS, given as intermittent theta burst stimulation (iTBS) over left Wernicke's area, on auditory comprehension in patients suffering from fluent aphasia after stroke of the left temporal lobe.

Methods: 

We studied 13 patients with chronic fluent aphasia after an ischemic stroke involving Wernicke's area. iTBS was applied in random order to Wernicke's area, the right-hemisphere homologous of Wernicke's area, and the primary visual cortex. Auditory comprehension was blind assessed using the Token test before (T0), 5 (T1), and 40 min (T2) after a single session of iTBS.

Results: 

At the first evaluation (T1) after iTBS on left Wernike's area, but not on the contralateral homologous area nor on the primary visual cortex, the scores on the Token test were significantly increased. No significant effects were observed at T2.

Conclusion: 

We demonstrated that a single session of excitatory iTBS over Wernicke's area was safe and led to a transient facilitation of auditory comprehension in chronic stroke patients with lesions in the same area. Further studies are needed to establish whether TBS-induced modulation can be enhanced and transformed into longer-lasting effects by means of repeated TBS sessions and by combining TBS with speech and language therapy.

Auditory, Phonological, and Semantic Factors in the Recovery From Wernicke’s Aphasia Poststroke: Predictive Value and Implications for Rehabilitation

Absolutely nothing useful here because they aren't even trying to create a protocol that will fix this aphasia.  The whole fucking point of stroke research is to get survivors recovered. This doesn't do that.

Auditory, Phonological, and Semantic Factors in the Recovery From Wernicke’s Aphasia Poststroke: Predictive Value and Implications for Rehabilitation 

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Holly Robson, PhD, Timothy D. Griffiths, DM, Manon Grube, PhD, ...

First Published August 16, 2019 Research Article

https://doi.org/10.1177/1545968319868709

Article information

Abstract

Background. Understanding the factors that influence language recovery in aphasia is important for improving prognosis and treatment. Chronic comprehension impairments in Wernicke’s aphasia (WA) are associated with impairments in auditory and phonological processing, compounded by semantic and executive difficulties. This study investigated whether the recovery of auditory, phonological, semantic, or executive factors underpins the recovery from WA comprehension impairments by charting changes in the neuropsychological profile from the subacute to the chronic phase.  
Method. This study used a prospective, longitudinal observational design. Twelve WA participants with superior temporal lobe lesions were recruited 2 months post–stroke onset (2 MPO). Language comprehension was measured alongside a neuropsychological profile of auditory, phonological, and semantic processing and phonological short-term memory and nonverbal reasoning at 3 poststroke time points: 2.5, 5, and 9 MPO.  
Results. Language comprehension displayed a strong and consistent recovery between 2.5 and 9 MPO. Improvements were also seen for slow auditory temporal processing, phonological short-term memory, and semantic processing but not for rapid auditory temporal, spectrotemporal, and phonological processing. Despite their lack of improvement, rapid auditory temporal processing at 2.5 MPO and phonological processing at 5 MPO predicated comprehension outcomes at 9 MPO. Conclusions. These results indicate that recovery of language comprehension in WA can be predicted from fixed auditory processing in the subacute stage. This suggests that speech comprehension recovery in WA results from reorganization of the remaining language comprehension network to enable the residual speech signal to be processed more efficiently, rather than partial recovery of underlying auditory, phonological, or semantic processing abilities.

Keywords stroke recovery, neuroplasticity, reorganization, auditory comprehension, aphasia

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Broca and Wernicke are dead, or moving past the classic model of language neurobiology

Is your doctor still using this dead terminology?
http://www.ncbi.nlm.nih.gov/pubmed/27584714

Tremblay P¹, Dick AS².

Author information

• ¹Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.
• ²Florida International University, Miami, FL, USA. Electronic address: adick@fiu.edu.

Abstract

With the advancement of cognitive neuroscience and neuropsychological research, the field of language neurobiology is at a cross-roads with respect to its framing theories. The central thesis of this article is that the major historical framing model, the Classic "Wernicke-Lichtheim-Geschwind" model, and associated terminology, is no longer adequate for contemporary investigations into the neurobiology of language. We argue that the Classic model (1) is based on an outdated brain anatomy; (2) does not adequately represent the distributed connectivity relevant for language, (3) offers a modular and "language centric" perspective, and (4) focuses on cortical structures, for the most part leaving out subcortical regions and relevant connections. To make our case, we discuss the issue of anatomical specificity with a focus on the contemporary usage of the terms "Broca's and Wernicke's area", including results of a survey that was conducted within the language neurobiology community. We demonstrate that there is no consistent anatomical definition of "Broca's and Wernicke's Areas", and propose to replace these terms with more precise anatomical definitions. We illustrate the distributed nature of the language connectome, which extends far beyond the single-pathway notion of arcuate fasciculus connectivity established in Geschwind's version of the Classic Model. By illustrating the definitional confusion surrounding "Broca's and Wernicke's areas", and by illustrating the difficulty integrating the emerging literature on perisylvian white matter connectivity into this model, we hope to expose the limits of the model, argue for its obsolescence, and suggest a path forward in defining a replacement.
Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Arcuate fasciculus; Broca’s area; Language connectome; Language neurobiology; Wernicke’s area

PMID:

27584714

DOI:

10.1016/j.bandl.2016.08.004

Scientists shift on brain speech centre

We need this kind of specificity if we are ever to get a decent damage diagnosis. 

Scientists shift on brain speech centre

The part of the brain used for speech processing is in a different location than originally believed, according to a US study that researchers say will require a rewrite of medical texts.

Wernicke's area, named after the German neurologist who proposed it in the late 1800s, was long believed to be at the back of the brain's cerebral cortex, behind the auditory cortex which receives sounds.

But a review by scientists at Georgetown University Medical Center of more than 100 imaging studies has shown it is actually three centimetres closer to the front of the brain, and is in front of the auditory cortex, not behind.

"Textbooks will now have to be rewritten," said neuroscience professor Josef Rauschecker, lead author of the study which appears in the Proceedings of the National Academy of Sciences.

"We gave old theories that have long hung a knockout punch."

Rauschecker and colleagues based their research on 115 previous peer-reviewed studies that investigated speech perception and used brain imaging scans - either MRI (functional magnetic resonance imaging) or PET (positron emission tomography).

An analysis of the brain imaging coordinates in those studies pointed to the new location for Wernicke's area, offering new insight for patients suffering from brain damage or stroke.

"If a patient can't speak, or understand speech, we now have a good clue as to where damage has occurred," says Rauschecker.

Humans and primates 'more similar'

It also adds an intriguing wrinkle to the origins of language in humans and primates, who have also been shown to process audible speech in the same region of the brain.

"This finding suggests the architecture and processing between the two species is more similar than many people thought."

Lead author Iain DeWitt, a PhD candidate in Georgetown's Interdisciplinary Program in Neuroscience, says the study confirms what others have found since brain imaging began in earnest in the 1990s, though some debate has persisted.

"The majority of imagers, however, were reluctant to overturn a century of prior understanding on account of what was then a relatively new methodology," he says.

"The point of our paper is to force a reconciliation between the data and theory."