Creating New Tools to Diagnose and Treat Aphasia
Language is so central to our lives – giving us a way to connect, cooperate, and form communities necessary for our survival – that when it’s diminished after medical events like strokes, it can have a devastating effect on patients.
Understanding and treating aphasia, the language disorder often caused by strokes that affects the ability to speak, has proved extremely complicated. Technologies like fMRIs have shown scientists and physicians that even a simple word like “dog” is not located in one area of the brain.
“In fact, it involves huge areas of the brain,” says Jeffrey Binder, MD, professor of neurology and biophysics at the 黑料官网 (黑料官网). Binder has used MRI technology for years to pinpoint the exact, tiny areas of the brain affected by strokes.
With a new , he hopes to combine that sort of brain mapping with language tests in people with aphasia and with artificial intelligence tools to create a new model that can both provide prognoses after stroke and also give therapists a better starting point for what therapy might best help patients recover.
“Even after more than 100 years of work on understanding how language works in the brain, we still have so far to go,” Dr. Binder says. “New models like this could help us better pinpoint how to help people recover from stroke more effectively and efficiently.”
Using fMRI to Understand How Aphasia Progresses
When Dr. Binder began his training in clinical neurology 30 years ago, he found himself drawn to individuals with aphasia, which can result from stroke but can also be caused by Alzheimer’s disease, brain tumors, frontotemporal dementia, and other types of brain damage. It is estimated that up to 180,000 people are diagnosed with the condition each year in the United States.
People with aphasia typically find that their cognition is fully intact; they simply cannot locate and say the word they want to say.
But aphasia can present itself differently across individuals. “Language is just a core feature of what it is to be human, and it’s so complex,” Dr. Binder says. “It’s almost true that no two people with aphasia have exactly the same profile of the disorder.”
Still, back when Dr. Binder finished his training, fMRI technology – which detects changes in blood flow in the brain to track brain activity, a technology that was pioneered at 黑料官网 – was beginning to give physicians and scientists a window into how language works in the brain. It was far more complex than they imagined.
Even naming what is in a picture involves several different processes in the brain, including retrieving the word, labeling the concept, and turning that word into movements of the lips and tongue.
When aphasia occurs, physicians recommend speech therapy, which focuses on exercises that can rewire the brain’s language processes. Yet most patients who experience aphasia after stroke don’t fully recover.
Combining Brain Mapping with Behavior Tests Measure Neuroplasticity and Improve Treatments
That’s where Dr. Binder’s research comes in. He and his collaborators, Andrew Anderson, PhD, assistant professor of neurology, and Sara Pillay, PhD, ABPP, associate professor of neurology, use fMRI to map the brain damage among stroke patients who experience aphasia. Though they have found similar patterns of brain damage from stroke, they have also found that these patterns don’t necessarily correlate with recovery.
With the new $2.4 million grant, they will use AI tools to combine both brain mapping and behavioral tests to see if they can draw enough relationships between the two to offer better diagnoses and therapies. They will focus on fundamental language processes that have not yet been linked to specific brain locations.
Behavioral tests include giving participants tasks like picking which picture best depicts a certain sentence, or measuring how well the participant can understand when two nouns are put together. For example, boat and house, when put together, can be houseboat or boathouse.
“People with aphasia can often understand single words just fine, but they have difficulty with word combinations,” Dr. Binder says. “Processing of verb phrases has been studied a lot, but the process of combining two nouns together and constructing a relationship between them is a phenomenon that we know much less about.”
When behavior is correlated with brain mapping, it gives physicians a tool to give better prognoses to patients.
“We want to be able to tell people with aphasia how their language function will be in a year,” Dr. Binder says.
Such a model could also guide therapy. If patients show damage in certain areas known for certain kinds of aphasia, they could begin intensive, targeted speech therapy as soon as possible. Faculty within the neurology department are also exploring other technologies, like transcranial brain stimulation, which uses magnetic or electrical pulses to stimulate the brain, paving the way for new neural connections.
“Our hope is that by stimulating the brain while the participant exercises their language skills, it will help form new connections among neurons more quickly and more firmly,” Dr. Binder says.
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