Class 3 - Recovery in Aphasia

What is spontaneous recovery?

aphasia will improve in most people regardless of whether they receive treatment

What most often experiences spontaneous recovery with aphasia?

language

What does recovery include?

all changes, such as restoration, reorganization, compensation etc. at neural and behavioural levels

What do people mean when they say recovery plateau's with aphasia?

people will recover for years and years, but when people say there is a plateau they are usually referring to language

What is neuroplasticity?

the brains capacity to change either at the microlevel (neural plasticity) or at the microlevel (behavioural plasticity) in response to environmental changes or changes in the organism itself

What is the typical recovery time course?

period of rapid recovery and steady improvement with gradually decreasing rate

Why do we see a rapid recovery initially?

likely due to resolution of edema and hypo perfusion

At the one year point, we say they are as good as they will be... what does this refer to?

this is if you look at scores on language tests --> this does not take into account other improvements

What is the general pattern of recovery when looking at language?

rapid recovery in first hours to 1 month

Why does slower long-term improvement occur?

likely due to functional compensation from intact brain regions

How does functional compensation from intact brain regions occur for undamaged LH regions?

surrounding areas can take over language functions (perilesional areas take over)
peri = next to

How does functional compensation from intact brain regions occur for homologous RH regions?

- homologous = same area (ex: Broca's area but not called that on the right)
- role is controversial.. we know RH is active, but is it helping? may be that the right hemisphere that is making errors, so RH is hindering recovery
- RH recruitment may be absent, adaptive or maladaptive (likely depends on person, task, strategy, timing)

Sustained functional recovery LIKELY depends on:

more on restoration and reorganization of LH language networks than RH compensation

How do we measure recovery?

99& of research is done using impairment scores, because that is easiest
we can also do function and quality of life

What is the problem with repeated testing?

testing/practice effects - people get better because they've seen these things better

People ____ widely in amount of recovery

vary

What is the rate of improvement using impairment scores?

most recovery occurs in the first 3 months, with less recovery after 1 year (lots of variability)

What is the rate of improvement using function or QOL scores?

may be ongoing throughout a person's life

What does final outcome refer to?

end of "recovery" (based on impairment) demonstrated by "plateau" in test scores

Core language skills often ____ return to premorbid levels

dont

What is the Life Participation Approach to Aphasia?

idea is that when people live with/recover from aphasia, there is more to it than language impairment

How does age impact recovery?

on average, those who are younger tend to recover better

How does sex impact recovery?

females tend to recover better than males

How does handedness impact recovery?

LH tend to recover better than RH

Why do females and LH recover better?

they tend to use more of both sides of the brain so they are better able to adapt

How does education and premorbid intelligence impact recovery?

people with higher intelligence or education prior to aphasia are more likely to find creative work arounds to their disabilities

How does type of injury impact recovery?

closed head TBI has better recovery than stroke because less damage is done to language areas, it is more swelling and that gets better with time

What is better for recovery, hemorraghic or ischemic stroke?

hemorraghic
*more death of tissue with ischemic, with hem it does not die

How does lesion size impact recovery?

smaller the lesion, better the recover
single lesion is better than multiple lesions

How does lesion site impact recovery?

- impact on marginal zones (around language areas) allows for better recovery compared to perislyvian lang zones
- subcortical > cortical

How do physical and psychological (ex: motor speech disorders, hemiplegia, depression, anxiety) issues impact recovery?

- added layer.. how do you practice word retrieval if you can't articulate? how do you get to appoints & have opportunity if you have trouble getting around physically?

The more severe the aphasia initially, the more challenging the:

recovery

How does auditory comprehension impact recovery?

recovery will be tougher if you dont understand what they are asking of you

How does type of apashia impact recovery?

- usually recover is more rapid and complete in TBI than in stroke

- initial deficits are the least severe in anomic and are the most severe in global aphasia

- rate of recovery varies somewhat across groups

- people can progress to one of the other aphasia types, but recovery often stops at anomic aphasia

*PEOPLE DO NOT CHANGE FROM FLUENT TO NON-FLUENT

How do behavioural variables impact recovery?

- likely enormously important but not well studied
ex: awareness of deficit, personality and motivation, social variables

CASE 1:
82 year old female
nursing home resident (since RH stroke 4 years ago)
large MCA infarction encompassing ant & post language zones
severe global aphasia & hemiplegia
8 months post-stroke

- probably won't improve much anymore in terms of IMPAIRMENT
- because: older, has both Broca's and Wernicke's, global, hemiplegia, and its 2nd stroke

CASE 2:
54 year old male
university-educated professional
circumscribed MCA infarction in Broca's area
moderate non-fluent aphasia
2 months post-stroke
supportive family

- probably a good prognosis, tell family with supports there is lots of potential but also we dont know what will happen "lets just give them the best support"
- good because: young, well educated, comprehension intact, still very recent, supportive family, it was small and contained (perilesional areas could take over)

CASE 3:
38 year old female
subcortical (caudate & putamen) infarction
moderate fluent aphasia
anosognosia
1 week post stroke
otherwise healthy

- We would have lots of hope for great recovery (even close to premorbid)
- because: young, female, subcortical, early, healthy
- tell family there is a lot to be optomistic about
*could be some challenges with her being unaware of difficulties

What are the 2 main recovery patterns in bilingual aphasia?

parallel (together) - languages improve in tandem
non-parallel (differently)

What are the 4 types of non-parallel recovery patterns in bilingual aphasia?

- differential: one language improves significantly more (most common)

- selective: only one languages improves at all

- blended: code-mixing/switching becomes markedly abnormal

- antagonistic: as one language improves, the other deteriorates

What are some possible factors that influence recovery in bilingual aphasia?

- age of acquisition
- premorbid proficiency
- frequency of use at time of stroke (what is your linguistic environment?)
- linguistic demands (how challenging is the language?)
- emotional attachments to language
- postmorbid frequency of use & linguistic environment