Boukrina Olga, Yamin Abubakar, Yue Guang H, Kong Yekyung, Koush Yury
Center for Stroke Rehabilitation Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA.
medRxiv. 2025 Jan 5:2025.01.03.25319980. doi: 10.1101/2025.01.03.25319980.
Reading impairments, a common consequence of stroke-induced aphasia, significantly hinder life participation, affecting both functional and leisure activities. Traditional post-stroke rehabilitation strategies often show limited generalization beyond trained materials, underscoring the need for novel interventions targeting the underlying neural mechanisms.
This study investigates the feasibility and potential effectiveness of real-time functional magnetic resonance imaging (fMRI) neurofeedback (NFB) intervention for reading deficits associated with stroke and aphasia. We enrolled left-hemisphere stroke survivors in the subacute recovery period and healthy controls in an fMRI NFB intervention study focusing on increasing activation within the left supramarginal gyrus (SMG), a critical region for reading supporting orthography-phonology conversion.
Preliminary findings demonstrate that stroke participants showed significant improvements in reading comprehension and phonological awareness, as evidenced by marked gains on the Reading Comprehension Battery for Aphasia (RCBA) and a phonology two-alternative forced choice test. Functional MRI results indicated that stroke participants exhibited increased activation from day 1 to day 3 of NFB training within the left SMG and the broader left hemisphere reading network, particularly during challenging nonword reading tasks. Healthy controls also showed increased activation during NFB regulation and reading tasks, but these changes were outside the traditional reading network, involving regions associated with cognitive control, reward anticipation, and learning. In both stroke participants and healthy controls, we also found changes in dynamic functional connectivity of multiple resting state networks from before to after NFB training.
Although preliminary, this research contributes to the development of biologically informed interventions for reading deficits in aphasia, representing an early step towards improving post-stroke rehabilitation outcomes. Future randomized controlled trials are necessary to validate these findings by including a sham NFB control group within a larger participant sample.
The study was preregistered on ClinicalTrials.gov, NCT# NCT04875936.
阅读障碍是中风所致失语症的常见后果，严重阻碍生活参与，影响功能和休闲活动。传统的中风后康复策略在训练材料之外的泛化效果往往有限，这凸显了针对潜在神经机制的新型干预措施的必要性。
本研究调查了实时功能磁共振成像（fMRI）神经反馈（NFB）干预对与中风和失语症相关的阅读缺陷的可行性和潜在有效性。我们招募了处于亚急性恢复期的左半球中风幸存者和健康对照者，进行一项fMRI NFB干预研究，重点是增加左顶上小叶（SMG）内的激活，左顶上小叶是支持正字法 - 语音转换的阅读关键区域。
初步研究结果表明，中风参与者在阅读理解和语音意识方面有显著改善，失语症阅读理解量表（RCBA）和语音二选一强制选择测试中的明显进步证明了这一点。功能磁共振成像结果表明，中风参与者在NFB训练的第1天到第3天，左SMG和更广泛的左半球阅读网络内的激活增加，特别是在具有挑战性的非单词阅读任务期间。健康对照者在NFB调节和阅读任务期间也表现出激活增加，但这些变化发生在传统阅读网络之外，涉及与认知控制、奖励预期和学习相关的区域。在中风参与者和健康对照者中，我们还发现NFB训练前后多个静息态网络的动态功能连接发生了变化。
尽管是初步研究，但本研究为失语症阅读缺陷的生物学导向干预措施的发展做出了贡献，代表了改善中风后康复结果的早期步骤。未来有必要进行随机对照试验，通过在更大的参与者样本中纳入假NFB对照组来验证这些发现。
该研究已在ClinicalTrials.gov上预注册，NCT编号为NCT04875936。
