Changes in Neuroplasticity Following Intensive Rehabilitation of Aphasia and/or Apraxia of Speech
Changes in Neuroplasticity Following Intensive Rehabilitation of Aphasia and/or Apraxia of Speech
The present study aims to investigate the short- and long-term effects of two weeks of
 intensive speech-language pathology intervention with additional physiotherapy, on aphasia
 and apraxia of speech (AOS) and their neural correlates in thirty persons with chronic
 stroke. Changes are studied following intensive treatment of aphasia and AOS with
 standardised speech-language testing and testing of communication and with voxel-based
 morphometry (VBM) analysis and resting state functional connectivity (rsFC).
This study explores structural and functional brain changes in relation to effects on speech,
 language, communication and quality of life following an intensive speech-language program
 with additional physiotherapy for persons with chronic aphasia and/or apraxia of speech. The
 participants are consecutively recruited from a rehabilitation centre providing intensive
 treatment for chronic conditions following stroke or other neurological injuries. The
 speech-language pathologists (SLPs) involved in the rehabilitation programs perform the
 testing directly before and after intensive intervention with an additional follow up after
 16 weeks (+-2) with testing of speech-language, communication and quality of life. The SLPs
 have more than five years of experience of working with aphasia and are specialised in
 working with intensive treatment, they have acquired in-depth knowledge on how to evaluate
 and treat aphasia and apraxia of speech in lectures and workshops. The test procedure is
 recorded with camcorder and voice recorder to provide the opportunity to access data
 retrospectively and to minimize bias by including an external SLP who makes a second blinded
 evaluation on randomized participants' performance in ASRS, BNT and CAT by studying the video
 and voice material. Structural and functional neuroplasticity is also investigated with
 voxel-based morphometry (VBM) analysis, resting state functional connectivity (rsFC) in
 domain-specific (language processing) and domain-general (executive and attention
 processing). This intensive neuro-rehabilitation program for speech and language deficits
 named Multimodal Intensive Rehabilitation for Aphasia and Apraxia of Speech (MIRAA) is
 defined as an ICAP (Intensive Comprehensive Aphasia Program) with focus on both speech and
 language function and communicative activity and participation. The program is intensive:
 consisting of ten days of training (5 hours/day), with a minimum of three hours dedicated to
 speech and language rehabilitation with additional physical therapy. The program includes
 both individual treatment, group therapy and computer-based therapy. The therapy is
 individually set up after the participant's goals together with the team including SLPs,
 physiotherapists and a board-certified neurologist and/or specialist in rehabilitation
 medicine. The goals are set by the participants, family members and clinicians the first day
 of the program. The participant and their significant other are offered education with the
 aim to enhance the knowledge on communication, the key concepts of neuroplasticity and other
 functions and strategies important in everyday life. The treatment methods being used are
 evidence-based and/or widely used multimodal programs covering the need for extensive
 training programs targeting both impairment-based therapy and functional communication. The
 specific questions are: Does ten days of with an intensive comprehensive aphasia/AOS program
 result in any clinical significant improvements in speech and/or language function and other
 cognitive skills for participants with chronic aphasia and/or apraxia of speech? Does the
 intensive intervention have any effect on the quality of everyday life concerning speech and
 language functions, activity and communicative participation for people with chronic aphasia
 and apraxia of speech? Can functional and anatomical brain changes be detected following ten
 days of intensive speech and language intervention for these participants?
Inclusion Criteria:

 -  Aphasia 7 months post stroke diagnosed by SLP

 -  Apraxia of Speech 7 months post stroke diagnosed by SLP

 Exclusion Criteria:

 -  Dementia

 -  Severe loss of sight

 -  Severe loss of hearing

 -  Metal implants (preventing fMRI)

 -  Claustrophobia (preventing fMRI)