Neurofeedback Intervention for Reading Deficits in Subacute Stroke

Kessler Foundation28 enrolled

Overview

The overall goal of this project is to advance a biologically-based approach to treatment of reading disorders after stroke, which will expand the limits of cognitive rehabilitation. Using a novel brain imaging technique, called real-time functional magnetic resonance imaging (fMRI) neurofeedback combined with right hand motor imagery, this project will re-instate brain activity in the left language-dominant hemisphere. Stroke patients will practice modulating their own brain activity using fMRI neurofeedback signal and will select the most effective mental strategies that help them maintain brain activation patterns associated with better reading recovery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Stroke Dyslexia, Acquired

Interventions

Survivors of left-hemisphere stroke (\<10 weeks post-stroke) or healthy volunteers will use right-hand motor imagery coupled with fMRI neurofeedback to help them re-engage the left hemisphere by shifting brain activation leftward relative to the initial left-right asymmetry. Following group assignment, participants will perform a motor imagery task and complete 3 sessions of motor imagery and reading tasks in the MRI scanner over 3 weeks. During the MRI sessions they will receive real time neurofeedback about how well they are engaging the left side of their brain compared to the right side. They will also practice the same task for 30 min a day as homework using the most effective motor imagery strategy that worked for them in the MRI scanner.

Motor Imagery and Sham fMRI NeurofeedbackBEHAVIORAL

Survivors of left-hemisphere stroke (\<10 weeks post-stroke) or healthy volunteers will practice right-hand motor imagery coupled with sham fMRI neurofeedback. As the experimental group, participants will perform a motor imagery task and complete 3 sessions of motor imagery and reading tasks in the MRI scanner over 3 weeks. However, during the MRI sessions they will receive sham neurofeedback on the basis of another participant's brain activity. Like the experimental group, they will also practice the same task for 30 min a day as homework.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * First-ever left-hemisphere stroke \< 3 months prior to study recruitment or healthy volunteer * Age: 18 - 80 years old * Fluent and literate in English prior to stroke * Reading deficits, defined as \>3 errors on the Paragraphs test (subtests VIII, IX) of the Reading Comprehension Battery for Aphasia-2nd ed. (RCBA-2) in keeping with the healthy control accuracy criterion of 86-100% correct. Exclusion Criteria: * Inability to consent or complete study tasks * Inability to undergo MRI (e.g., pregnancy, non-MRI compatible implants, claustrophobia) * A history of prior neurological disease (e.g., brain tumor, Alzheimer's disease)

Outcomes

Primary Outcomes

Reading Aloud Accuracy

Read aloud 136 words to produce an accuracy score in percent correct.

Time frame: change from baseline at intervention week 1, 2, and 3

fMRI Brain Activity

Whole-brain and region of interest activation and resting state functional connectivity

Time frame: change from baseline at intervention week 1, 2, and 3

Secondary Outcomes

Reading Comprehension Battery for Aphasia (RCBA-2)

Letter, word, sentence, paragraph and text-level reading comprehension test designed for aphasia. Score range 0-100, higher scores correspond to better reading ability.