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Poster A35, Wednesday, November 8, 10:30 – 11:45 am, Harborview and Loch Raven Ballrooms

Increased connectivity with right hemisphere homologues of language areas following melody-based intervention in a patient with aphasia

Tali Bitan1,2, Cristina Saverino3, Tijana Simic2,3,4, Cheryl Jones2, Joanna Glazer3, Brenda Colella3, Catherine Wiseman-Hakes3, Robin Green2,3, Elizabeth Rochon2,3,4;1University of Haifa, Israel, 2University of Toronto, Canada, 3Toronto Rehabilitation Institute, Canada, 4Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Canada

The role of the right hemisphere (RH) in compensating for left hemisphere (LH) damage during language processing in patients with aphasia has been called into question lately. Although melody-based treatments, assumed to rely on the preserved musical abilities of the RH were shown to be effective [1], there are still open questions regarding the role of the RH in this outcome. While structural imaging studies show changes in white-matter volume and connectivity in right frontal areas [2, 3], functional imaging studies, measuring treatment-related changes in local activation are less consistent [4, 5]. The current study measured changes in resting state functional connectivity following melody-based intervention, to identify lateralization of treatment-related changes. A 50 year-old female, with extensive left fronto-temporal damage following two temporally proximal events of moderate-severe traumatic brain injury (TBI), was examined 3.2 years after her injury. Her language assessment showed moderate-severe non-fluent aphasia with severe naming impairment, moderate comprehension deficits, and mild impairments in all other cognitive domains. She received 45 sessions of melody-based intervention, 30 min each, which included intoned repetition or completion of phrases and left-hand tapping. Treatment lasted for 15 weeks, and performance on treated and untreated phrases was tested pre- and post-treatment, and 8-weeks following the end of treatment. Resting state fMRI data were collected at three time points: T1- baseline, T2-immediately before treatment and T3-immediately after treatment. A case-matched control TBI patient was also scanned at the same intervals. Behavioral results show improvement on repetition of long treated phrases, but not untreated phrases. However, sentence completion and answering question probes improved for both treated and untreated phrases and was maintained during follow-up. Resting state connectivity was measured between areas associated with speech motor control (bilateral supplementary motor area-SMA, precentral gyri and insulae) and frontal language areas associated with production (bilateral inferior frontal gyri-IFG opercularis, triangularis and orbitalis). Changes during the treatment interval (T3-T2) were compared to changes during the baseline interval (T2-T1) for each patient separately. The treated patient showed a greater increase in connectivity between bilateral SMA and RH language areas (R.SMA-R.IFG triangularis; L.SMA-R.IFG opercularis) during the treatment period, compared to the baseline interval. LH language areas showed only decreases in connectivity during treatment. Furthermore, connectivity changes in the control patient occurred only for LH language areas. This study is the first to show changes in functional connectivity following melody-based treatment. The results support a compensatory role for RH language areas following melody-based intervention. The emphasis on musical elements, and the left hand tapping, which typically recruit the RH, may have strengthened the connections between RH language areas and speech motor control areas necessary for language production. 1. van der Meulen, I., et al., Archives of Physical Medicine and Rehabilitation, 2012. 93: p. S46-S52. 2. Wan, C.Y., et al. Brain and Language, 2014. 136: p. 1-7. 3. Zipse, L., et al. Neurosciences and Music Iv: Learning and Memory, 2012. 1252: p. 237-245. 4. Schlaug, G., et al. Music Perception, 2008. 25: p. 315-323. 5. Jungblut, M., et al. Neural Plasticity, 2014.

Topic Area: Language Therapy

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