When more yields less: Understanding therapeutic gains according to lesion profile in chronic stroke aphasia.

Aphasia is a common consequence of stoke ultimately affecting one in five cases, with the most common residual difficulty being word finding difficulties, or anomia. The inability to speak fluently limits patients’ recovery from stroke and hence has a negative impact of daily function and mental wellbeing. Treatment of language deficits in chronic aphasia is therefore a priority area, but it variable gains are seen over patients, making it challenging to determine the best treatment. The factors affecting treatment effectiveness for any give individual 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. One popular approach, as represented in a number of recently developed computerised therapy packages, is to adopt a multimodal approach, where the patient is presented with information about the meaning of a word, the pronunciation of word, and the articulatory gestures to produce the word (e.g., Sandars et al., 2017). The logic behind this approach is some aspect of the therapy will work to remediate the root cause of the anomia, and other aspects could strengthen this effect. We have recently acquired data that has indicated that, for some patients with a particular lesion profile, the multimodal approach is actually less effective than one that focusses on specific aspects. This project will use structural and functional imaging to predict patient response to multimodal vs unimodal therapies. In doing so, it will allow us to tailor therapy for anomia to the individual patient based upon their lesion profile, optimising its effectiveness.

Training/techniques to be provided:

This project will involve training in case series neuropsychological assessment and analysis, experience of working with clinical populations with communication impairments, creation of therapeutic intervention and analysis of gains, acquisition, processing and analyses of multimodal imaging data relating to brain integrity, connectivity and function, and techniques to relate behaviour and imaging data.

Entry Requirements
Candidates are expected to hold a minimum upper second class honours degree (or equivalent) in a relevant subject area, which includes psychology, neuroscience or speech and language therapy, and candidates with a medical degree will also be considered. Candidates with experience in neuroimaging analysis and/or working with patients with neurological impairments or with an interest in the neural basis of and treatment for language disorders are encouraged to apply. Informal enquiries may be made directly to the primary supervisor.

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