Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece.
Department of Neurology, University Hospital of Larisa, University of Thessaly, Larisa, Greece.
Behav Neurol. 2019 Jul 22;2019:9894571. doi: 10.1155/2019/9894571. eCollection 2019.
Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain "understands," "speaks," and "writes," and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks ("streams"), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.
人类的交流活动几乎激活了大脑的每一个部位。当然，语言的运用占据主导地位，但其他认知功能，如注意力、记忆、情感和执行过程也都涉及其中。然而，为了阐释我们的大脑是如何“理解”、“说话”和“写作”的，并且为了对失语症障碍进行康复治疗，神经科学多年来一直面临着揭示相关神经网络的艰巨挑战。在 19 世纪，当大脑研究主要是观察性的和基于尸检的时，布洛卡（Broca）和韦尼克（Wernicke）（还有利希滕豪尔姆（Lichtheim）和许多其他人）就对大脑和语言提供了基础性的认识，因此，韦尼克-格施温德（Wernicke-Geschwind）模型应运而生，并且 20 世纪的失语症学也是以此为基础的。该模型对于对经典的失语症综合征进行初步分类仍然有用，但是它已经过时了，因为它不能充分描述与语言相关的神经网络，并且它提供了一种模块化的视角，主要关注皮质结构。在过去的三十年中，神经科学为大脑研究征服了新的成像、记录和操作技术，语言功能的神经解剖学的新模型——双流模型也被开发出来，该模型由两个相互作用的网络（“流”）组成，一个是双侧的腹侧网络，用于语言理解，另一个是左半球优势的背侧网络，用于语言产生。这个新模型也有其局限性，但它帮助我们理解了为什么不同脑损伤的患者会有相似的语言障碍。此外，研究衰老大脑（以及年轻、发育中的大脑）和认知受损患者的语言功能以及神经调节对语言相关脑网络重组的影响，也出现了有趣的方面。在这篇选择性综述中，我们讨论了将大脑功能重组的新知识与能够激活现有支持网络的复杂技术相结合的方法，以便为患有神经源性交流障碍的人提供改进的神经康复策略。
