(MRC DTP) Learning from your mistakes? Using electrophysiological indices of error monitoring to optimise treatment of stroke aphasia

Aphasia is a common consequence of stoke, affecting 30% of survivors. Unfortunately, language difficulties persist in 20% of cases, with the most common residual difficulty being anomia, which is characterised by word finding difficulties. The inability to speak fluently has a substantial negative impact on daily function and wellbeing. Treatment of language deficits in chronic aphasia is therefore an important area for development, but it has proven challenging, with variable gains over patients. The factors affecting treatment effectiveness at the individual level remain poorly understood. This is because there are multiple causes for word finding difficulties within the language system (Butler et al., 2014), and moreover lesions in aphasic patients commonly impinge upon other areas involved in more general cognitive abilities, such as memory and executive functions, which also impact upon ability to re-learn language.

At present, there is considerable variation in the type of therapeutic interventions offered to patients with stroke aphasia for their anomia. These range from approaches that seek to avoid production of errors by presenting patients with correct information for passive re-learning, through to effortful and errorful production to minimal cues with or without corrective feedback. The findings in the aphasia rehabilitation literature in have proven inconsistent, particularly with reference to the impact of feedback (McKissok & Ward, 2007; Fillingham et al., 2005). What is most needed to provide effective rehabilitation for aphasia is a way in which to determine for each patient what the most appropriate form of behavioural therapy might be according to the nature of their brain damage (Holland et al., 2016)

This project will pursue the hypothesis that a key factor in determining the success of therapy for anomia is an individual’s error monitoring ability. This capacity is supported by brain areas proximal and interconnected to key language production regions and will be variably affected in different aphasic patients according to the precise location of their lesion. The project will harness the power of detailed structural and functional neuroimaging and combine this with electrophysiological indices of error monitoring. Therapeutic response to therapy with and without feedback will be related back to patients’ lesion profiles in terms of neural integrity and connectivity. This project has the potential to optimise treatment selection for chronic stroke aphasia at the individual level, providing personalised intervention tailored to each person’s strengths and weaknesses
https://www.research.manchester.ac.uk/portal/en/researchers/anna-woollams(96630ee8-41fa-4d18-bdf8-6e51ae8bb707).html
https://www.research.manchester.ac.uk/portal/en/researchers/lauren-cloutman(bf73a0d6-719f-413b-a78c-339bf3f50e98).html
https://www.research.manchester.ac.uk/portal/en/researchers/jason-taylor(4cd5c2f1-6e6d-40b1-894c-6015f196a286).html