RESUMO
Expressive dysphasia accompanies left inferior frontal gyrus (IFG/Broca) injury. Recovery may relate to interhemispheric balance with homologous, contralesional IFG but is unexplored in children. We evaluated effects of inhibitory rTMS to contralesional IFG combined with intensive speech therapy (SLT). A 15year-old, right-handed male incurred a left middle cerebral artery stroke. After 30months, severe non-fluent dysphasia impacted quality of life. Language networks, neuronal metabolism and white matter pathways were explored using MRI. Language function was measured longitudinally. An intensive SLT program was combined with contralesional inhibitory rTMS of right pars triangularis. Procedures were well tolerated. Language function improved persisting to four months. Post-treatment fMRI demonstrated increased left perilesional IFG activations and connectivity at rest. Bilateral changes in inositol and glutamate metabolism were observed. Contralesional, inhibitory rTMS appears safe in childhood stroke-induced dysphasia. We observed clinically significant improvements after SLT coupled with rTMS. Advanced neuroimaging can evaluate intervention-induced plasticity.
Assuntos
Afasia de Broca/terapia , Mapeamento Encefálico , Terapia da Linguagem , Imagem Multimodal , Plasticidade Neuronal , Acidente Vascular Cerebral/complicações , Estimulação Magnética Transcraniana , Adolescente , Afasia de Broca/etiologia , Afasia de Broca/patologia , Afasia de Broca/fisiopatologia , Área de Broca/patologia , Área de Broca/fisiopatologia , Lateralidade Funcional , Ácido Glutâmico/metabolismo , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Inositol/metabolismo , Imageamento por Ressonância Magnética , Masculino , Neurônios/metabolismo , Qualidade de Vida , Descanso , Fonoterapia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana/efeitos adversos , Substância Branca/patologia , Substância Branca/fisiopatologiaRESUMO
Children with expressive phonological delays often possess poor underlying perceptual knowledge of the sound system and show delayed development of segmental organization of that system. The purpose of this study was to investigate the benefits of a perceptual approach to the treatment of expressive phonological delay. Thirty-four preschoolers with moderate or severe expressive phonological delays received 16 treatment sessions in addition to their regular speech-language therapy. The experimental group received training in phonemic perception, letter recognition, letter-sound association, and onset-rime matching. The control group listened to computerized books. The experimental group showed greater improvements in phonemic perception and articulatory accuracy but not in phonological awareness in comparison with the control group.
