2009 | 45 | 2 | 313-326
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A Biological basis for Aphasia Treatment: Mirror Neurons and Observation-Execution Matching

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Aphasia is caused by damage to the human brain, and recovery requires adaptive changes to the structure and function of this organ. Despite this obvious fact, biology plays little role in rehabilitation of persons with aphasia. Although linguistics can be useful in characterizing aphasic behaviour, thus providing a way to assess the effects of therapy, there is little evidence to suggest that linguistic models of impairment can themselves form the basis of effective therapy.Biological evidence from primates has demonstrated the presence of neurons that have both visual and motor properties, which discharge both when an action is performed and during observation of the same action. We postulate that behavioural stimulation of this system may play an important role in motor learning for speech and thereby aid language recovery after stroke.IMITATE is a computer-assisted system for aphasia therapy based on action observation and imitation. IMITATE therapy consists of silent observation of audio-visually presented words and phrases spoken aloud by six different speakers, followed by a period during which the participant orally repeats the stimuli. The treatment approach is motivated by the physiology of the brain in an effort to change specific anatomical connections, and the treatment method draws strongly from psychological evidence on learning.IMITATE is currently being used in a clinical trial, and results will not be known until these data are available in late 2010. At that juncture, it will be possible to evaluate fully the efficacy of IMITATE and to inform theoretically about the mechanism of action and the role of a human mirror system in aphasia treatment.
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  • The University of Chicago
  • Alberts, M.J., G. Hademenos, R.E. Latchaw, A. Jagoda, J.R. Marler, M.R. Mayberg, R.D. Starke, H.W. Todd, K.M. Viste, M. Girgus, T. Shephard, M. Emr, P. Shwayder and M.D. Walker. 2000. "Recommendations for the establishment of primary stroke centers. Brain Attack Coalition". Journal of the American Medical Association 283. 3102-3109.
  • American Heart Association. 2003. Heart and stroke statistical update. Dallas, TX: American Heart Association.
  • Aziz-Zadeh, L., S.M. Wilson, G. Rizzolatti and M. Iacoboni. 2006. "Congruent embodied representations for visually presented actions and linguistic phrases describing actions". Current Biology 16. 1818-1823.[Crossref]
  • Basso, A. 1993. "Therapy for aphasia in Italy". In: Holland, A.L. and M.M. Forbes (eds.), Aphasia treatment: World perspectives. San Diego, CA: Singular Publishing Group. 1-24.
  • Beilock, S.L., I.M. Lyons, A. Mattarella-Micke, H.C. Nusbaum and S.L. Small. 2008. "Sports experience changes the neural processing of action language". Proceedings of the National Academy of Sciences of the United States of America 105. 13269-13273.
  • Benson, D.F., and N. Geschwind. 1989. "The aphasias and related disturbances". In: Joynt, R. (ed.), Clinical neurology. Philadelphia: J.B. Lippincott Company. 1-28.
  • Bhogal, S.K., R. Teasell and M. Speechley. 2003. "Intensity of aphasia therapy, impact on recovery". Stroke 34. 987-993.[Crossref][PubMed]
  • Blumstein, S.E., E. Baker and H. Goodglass. 1977. "Phonological factors in auditory comprehension in aphasia". Neuropsychologia 15. 19-30.[PubMed][Crossref]
  • Broca, P.P. 1861. "Nouvelle observation d'aphémie produite par une lesion de la partie postérieure des deuxième et troisième circonvolutions frontales". Bulletin de la Société anatomique de Paris 6. 398-407.
  • Buccino, G., F. Binkofski, G.R. Fink, L. Fadiga, L. Fogassi, V. Gallese, R.J. Seitz, K. Zilles, G. Rizzolatti and H.J. Freund. 2001. "Action observation activates premotor and parietal areas in a somatotopic manner: an fMRI study". European Journal of Neuroscience 13. 400-404.
  • Buccino, G., F. Lui, N. Canessa, I. Patteri, G. Lagravinese, F. Benuzzi, C.A. Porro and G. Rizzolatti. 2004a. "Neural circuits involved in the recognition of actions performed by nonconspecifics: An FMRI study". Journal of Cognitive Neuroscience 16. 114-126.[Crossref]
  • Buccino, G., S. Vogt, A. Ritzl, G.R. Fink, K. Zilles, H.J. Freund and G. Rizzolatti. 2004b. "Neural circuits underlying imitation learning of hand actions: An event-related FMRI study". Neuron 42. 323-334.[Crossref][PubMed]
  • Canseco-Gonzalez, E., L.P. Shapiro, E.B. Zurif and E. Baker. 1990. "Predicate-argument structure as a link between linguistic and nonlinguistic representations". Brain and Language 39. 391-404.
  • Caplan, D., and G.S. Waters. 1999. "Verbal working memory and sentence comprehensio". Behavioural and Brain Sciences 22. 77-94. (Discussion 95-126.)
  • Caramazza, A. 1989. "Cognitive neuropsychology and rehabilitation: An unfulfilled promise?" In: Seron, X. and G. Deloche (eds.), Cognitive approaches in neuropsychological intervention. Hillsdale, NJ: Lawrence Erlbaum Associates. 383-398.
  • Caspari, I., S.R. Parkinson, L.L. LaPointe and R.C. Katz. 1998. "Working memory and aphasia". Brain and Cognition 37. 205-223.[Crossref]
  • Centers for Disease Control and Prevention. May 18, 2007. "Prevalence of Stroke - United States, 2005". In: Morbidity and Mortality Weekly Report. Government Printing Office. 469-474.
  • Cherney, L.R., A.S. Halper, A.L. Holland and R. Cole. 2008. "Computerised script training for aphasia: Preliminary results". American Journal Speech Language-Pathology 17. 19-34.[Crossref]
  • Chomsky, N. 1965. Aspects of the theory of syntax. Cambridge, MA: MIT Press.
  • Crerar, M.A., A.W. Ellis and E.C. Dean. 1996. "Remediation of sentence processing deficits in aphasia using a computer-based microworld". Brain and Language 52. 229-275.[Crossref]
  • Duffy, J.R. 1995. Motor speech disorders: Substrates, differential diagnosis, and management. Philadelphia, PA: Mosby.
  • Elman, J.L. 1990. "Finding structure in time". Cognitive Science 14. 179-211.[Crossref]
  • Elman, J.L. 1993. "Learning and development in neural networks: The importance of starting small". Cognition 48. 71-99.[Crossref][PubMed]
  • Fadiga, L., L. Fogassi, G. Pavesi and G. Rizzolatti. 1995. "Motor facilitation during action observation: A magnetic stimulation study". Journal of Neurophysiology 73. 2608-2611.
  • Fadiga, L., L. Craighero, G. Buccino and G. Rizzolatti. 2002. "Speech listening specifically modulates the excitability of tongue muscles: A TMS study". European Journal of Neuroscience 15. 399-402.[Crossref]
  • Fang, J. and M.H. Alderman. 2001. "Trend of stroke hospitalisation, United States, 1988-1997". Stroke 32. 2221-2226.[Crossref][PubMed]
  • Ferrari, P.F., S. Rozzi and L. Fogassi. 2005. "Mirror neurons responding to observation of actions made with tools in monkey ventral premotor cortex". Journal of Cognitive Neuroscience 17. 212-226.[Crossref]
  • Fitch, J.L. 1983. "Telecomputer treatment for aphasia". Journal of Speech and Hearing Disorders 48. 335-336.
  • Gallese, V., L. Fadiga, L. Fogassi and G. Rizzolatti. 1996. "Action recognition in the premotor cortex". Brain 119(2) 593-609.
  • Gallese, V. 2003. "A neuroscientific grasp of concepts: from control to representation". Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 358. 1231-1240.
  • Goodglass, H. 1993. Understanding aphasia. San Diego, CA: Academic Press.
  • Goodglass, H. 1997. "Agrammatism in aphasiology". Clinical Neuroscience 4. 51-56.
  • Grawemeyer, B., R. Cox and C. Lum. 2000. "AUDIX: A knowledge-based system for speech-therapeutic auditory discrimination exercises". Studies in Health Technology and Informatics 77. 568-572.
  • Graziano, M.S., C.S. Taylor, T. Moore and D.F. Cooke. 2002. "The cortical control of movement revisited". Neuron 36. 349-362.[PubMed][Crossref]
  • Grodzinsky, Y. 1986. "Language deficits and theory of syntax". Brain and Language 27. 135-159.[Crossref]
  • Hacke, W., M. Kaste, C. Fieschi, D. Toni, E. Lesaffre, R. von Kummer, G. Boysen, E. Bluhmki, G. Hoxter and M.H. Mahagne. 1995. "Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)". Journal of the American Medical Association 274. 1017-1025.
  • Heilman, K.M., and R.J. Scholes. 1976. "The nature of comprehension errors in Broca's, conduction, and Wernicke's aphasics". Cortex 12. 258-265.[Crossref]
  • Hoyert, D.L., E. Arias, B.L. Smith, S.L. Murphy and K.D. Kochanek. 2001. "Deaths: Final data for 1999". National Vital Statistics Report 49. 1-117.
  • Huber, W., L. Springer and K. Willmes. 1993. "Approaches to aphasia therapy in Aachen". In: Holland, A.L. and M.M. Forbes (eds.), Aphasia treatment: World perspectives. San Diego, CA: Singular Publishing Group. 55-86.
  • Iacoboni, M., R.P. Woods, M. Brass, H. Bekkering, J.C. Mazziotta and G. Rizzolatti. 1999. "Cortical mechanisms of human imitation". Science 286. 2526-2528.
  • Iacoboni, M., L.M. Koski, M. Brass, H. Bekkering, R.P. Woods, M.C. Dubeau, J.C. Mazziotta and G. Rizzolatti. 2001. "Reafferent copies of imitated actions in the right superior temporal cortex". Proceedings of the National Academy of Sciences of the United States of America 98. 13995-13999.
  • Iacoboni, M. 2003. "Neural circuitry of imitation: The human homologues of monkey STS, PF, and F5". Paper presented at the Human Brain Mapping conference, New York.
  • Katz, R.C. and R.T. Wertz. 1997. "The efficacy of computer-provided reading treatment for chronic aphasic adults". Journal of Speech, Language, and Hearing Research 40. 493-507.
  • Kertesz, A., and P. McCabe. 1977. "Recovery patterns and prognosis in aphasia". Brain 100. 1-18.[PubMed][Crossref]
  • Kertesz, A. 1982. The Western Aphasia Battery. New York: Grune and Stratton.
  • Kiran, S. and C.K. Thompson. 2003. "The role of semantic complexity in treatment of naming deficits: Training semantic categories in fluent aphasia by controlling exemplar typicality". Journal of Speech, Language and Hearing Research 46. 608-622.[Crossref]
  • Kohler, E., C. Keysers, M.A. Umilta, L. Fogassi, V. Gallese and G. Rizzolatti. 2002. "Hearing sounds, understanding actions: Action representation in mirror neurons". Science 297. 846-848.
  • Lecours, A.R., F. Lhermitte and B. Bryans. 1983. Aphasiology. London: Baillière Tindall.
  • Mackay, J. and G.A. Mensah. 2004. The atlas of heart disease and stroke. Geneva: World Health Organisation.
  • Magnuson, J.S., and H.C. Nusbaum. 2007. "Acoustic differences, listener expectations, and the perceptual accommodation of talker variability". Journal of Experimental Psychology: Human Perception and Performance 33. 391-409.[Crossref]
  • Martin, N., G.S. Dell, E.M. Saffran and M.F. Schwartz. 1994. "Origins of paraphasias in deep dysphasia: Testing the consequences of a decay impairment to an interactive spreading activation model of lexical retrieval". Brain and Language 47. 609-660.[Crossref]
  • Mashal, N., A. Solodkin, E.E. Chen and S.L. Small. In press. "A mirror neuron system for human speech demonstrated through a network model of observation and imitation". Brain and Language.
  • Merzenich, M.M., W.M. Jenkins, P. Johnston, C. Schreiner, S.L. Miller and P. Tallal. 1996. "Temporal processing deficits of language-learning impaired children ameliorated by training". Science 271. 77-81.
  • Milberg, W., S. Blumstein and B. Dworetzky. 1988. "Phonological processing and lexical access in aphasia". Brain and Language 34. 279-293.[Crossref]
  • Mohr, J.P. 1976. "Broca's area and Broca's aphasia". In: Whitaker, H. and H. Whitaker (eds.), Studies in neurolinguistics. New York: Academic Press. 201-233.
  • Murata, A., L. Fadiga, L. Fogassi, V. Gallese, V. Raos and G. Rizzolatti. 1997. "Object representation in the ventral premotor cortex (area F5) of the monkey". Journal of Neurophysiology 78. 2226-2230.
  • Naeser, M.A., E.H. Baker, C.L. Palumbo, M. Nicholas, M.P. Alexander, R. Samaraweera, M.N. Prete, S.M. Hodge and T. Weissman. 1998. "Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program". Archives of Neurology 55. 1438-1448.[Crossref]
  • NIDCD. 1997. Aphasia. National Institute of Deafness and Other Communication Disorders.
  • Pedersen, P.M., H.S. Jorgensen, H. Nakayama, H.O. Raaschou and T.S. Olsen. 1995. "Aphasia in acute stroke: Incidence, determinants, and recovery". Annals of Neurology 38. 659-666.[Crossref]
  • Rizzolatti, G., L. Fadiga, V. Gallese and L. Fogassi. 1996. "Premotor cortex and the recognition of motor actions". Brain Research. Cognitive Brain Research 3. 131-141.[PubMed][Crossref]
  • Rizzolatti, G. and M.A. Arbib. 1998. "Language within our grasp". Trends in Neurosciences 21. 188-194.[Crossref]
  • Rizzolatti, G. and M.A. Arbib. 1999. "From grasping to speech: Imitation might provide a missing link: Reply". Trends in Neurosciences 22. 152.[Crossref]
  • Rizzolatti, G., L. Fogassi and V. Gallese. 2002. "Motor and cognitive functions of the ventral premotor cortex". Current Opinion in Neurobiology 12. 149-154.[Crossref]
  • Rizzolatti, G. and L. Craighero. 2004. "The mirror-neuron system". Annual Review of Neuroscience 27. 169-192.[Crossref]
  • Robey, R.R. 1998. "A meta-analysis of clinical outcomes in the treatment of aphasia". Journal of Speech, Language, and Hearing Research 41. 172-187.
  • Romanski, L.M. and P.S. Goldman-Rakic. 2002. "An auditory domain in primate prefrontal cortex". Nature Neuroscience 5. 15-16.[Crossref][PubMed]
  • Rosamond, W., K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, S. Kittner, D. Lloyd-Jones, M. McDermott, J. Meigs, C. Moy, G. Nichol, C.J. O'Donnell, V. Roger, J. Rumsfeld, P. Sorlie, J. Steinberger, T. Thom, S. Wasserthiel-Smoller and Y. Hong. 2007. "Heart disease and stroke statistics - 2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee". Circulation 115. e69-171.[Crossref]
  • Skipper, J.I., H.C. Nusbaum and S.L. Small. 2006. "Lending a helping hand to hearing: A motor theory of speech perception". In: Arbib, M.A. (ed.), Action to language via the mirror neuron system. Cambridge: Cambridge University Press. 250-286.
  • Skipper, J.I., S. Goldin-Meadow, H.C. Nusbaum and S.L. Small. 2007a. "Speech-associated gestures, Broca's area, and the human mirror system". Brain and Language 101. 260-277.[Crossref]
  • Skipper, J.I., V. van Wassenhove, H.C. Nusbaum and S.L. Small. 2007b. "Hearing lips and seeing voices: How cortical areas supporting speech production mediate audiovisual speech perception". Cerebral Cortex 17. 2387-2399.[Crossref]
  • Small, S.L. 2004a. "Therapeutics in cognitive and behavioural neurology". Annals of Neurology 56. 5-7.[Crossref]
  • Small, S.L. 2004b. "A biological model of aphasia rehabilitation: Pharmacological perspectives". Aphasiology 18. 473-492.[Crossref]
  • Small, S.L. 2008. "The neuroscience of language". Brain and Language 106. 1-3.[Crossref]
  • Steele, R., M. Weinrich, R.T. Wertz, M.K. Kleczewska and G.S. Carlson. 1989. "Computer-based visual communication in aphasia". Neuropsychologia 27. 409-426.[Crossref][PubMed]
  • Sutton, R.S. and A.G. Barto. 1998. "Reinforcement learning: An introduction. Cambridge, MA: MIT Press.
  • Swinney, D. and E. Zurif. 1995. "Syntactic processing in aphasia". Brain and Language 50. 225-239.[Crossref]
  • Tallal, P., S.L. Miller, G. Bedi, G. Byma, X. Wang, S.S. Nagarajan, C. Schreiner, W.M. Jenkins and M.M. Merzenich. 1996. "Language comprehension in language-learning impaired children improved with acoustically modified speech". Science 271. 81-84.
  • Taub, E., J.E. Crago, L.D. Burgio, T.E. Groomes, E.W. Cook, 3rd, S.C. DeLuca and N.E. Miller. 1994. "An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping". Journal of the Experimental Analysis of Behaviour 61. 281-293.
  • Tettamanti, M., G. Buccino, M.C. Saccuman, V. Gallese, M. Danna, P. Scifo, F. Fazio, G. Rizzolatti, S.F. Cappa and D. Perani. 2005. "Listening to action-related sentences activates fronto-parietal motor circuits". Journal of Cognitive Neuroscience 17. 273-281.[Crossref]
  • The NINDS rt-PA Stroke Study Group. 1995. "Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group". New England Journal of Medicine 333. 1581-1587.
  • Tobin, Y. 2002. "Phonology as human behavior". In: Fava, E. (ed.), Clinical linguistics: Theory and applications in speech pathology and therapy. Philadelphia: John Benjamins. 3-22.
  • Tomasello, M., S. Savage-Rumbaugh and A.C. Kruger. 1993. "Imitative learning of actions on objects by children, chimpanzees, and enculturated chimpanzees". Child Development 64. 1688-1705.[Crossref][PubMed]
  • Tseng, C.-H., M.R. McNeil and P. Milenkovic. 1993. "An investigation of attention allocation deficits in aphasia". Brain and Language 45. 276-296.[Crossref]
  • Weinrich, M. 1997. "Computer rehabilitation in aphasia". Clinical Neuroscience 4. 103-107.
  • Weinrich, M., J.R. Shelton, D.M. Cox and D. McCall. 1997a. "Remediating production of tense morphology improves verb retrieval in chronic aphasia". Brain and Language 58. 23-45.[Crossref]
  • Weinrich, M., J.R. Shelton, D. McCall and D.M. Cox. 1997b. "Generalisation from single sentence to multisentence production in severely aphasic patients". Brain and Language 58. 327-352.[Crossref]
  • Weinrich, M., D. McCall, K.I. Boser and T. Virata. 2002. "Narrative and procedural discourse production by severely aphasic patients". Neurorehabilitation and Neural Repair 16. 249-274.[Crossref]
  • Wernicke, C. 1874. Der aphasische Symptomenkomplex. Breslau: Cohn & Weigert.
  • Wilson, S.M., A.P. Saygin, M.I. Sereno and M. Iacoboni. 2004. "Listening to speech activates motor areas involved in speech production". Nature Neuroscience 7. 701-702.[Crossref][PubMed]
  • Wong, P.C., H.C. Nusbaum and S.L. Small. 2004. "Neural bases of talker normalisation". Journal of Cognitive Neuroscience 16. 1173-1184.[Crossref]
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