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Imaging short- and long-term training success in chronic aphasia

Ricarda Menke12, Marcus Meinzer13*, Harald Kugel4, Michael Deppe1, Annette Baumgärtner5, Hagen Schiffbauer4, Marion Thomas1, Kira Kramer1, Hubertus Lohmann1, Agnes Flöel1, Stefan Knecht16 and Caterina Breitenstein1

  • * Corresponding author: Marcus Meinzer

  • † Equal contributors

Author Affiliations

1 Department of Neurology, University of Münster, Münster, Germany

2 Department of Clinical Neurology, Oxford University, Oxford, UK

3 Department of Clinical & Health Psychology, University of Florida, Gainesville, USA

4 Department of Clinical Radiology, University of Münster, Münster, Germany

5 Department of Health Sciences, Hochschule Fresenius, University of Applied Sciences, Hamburg, Germany

6 Neurocenter, Schön Klinik, Hamburg, Germany

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BMC Neuroscience 2009, 10:118  doi:10.1186/1471-2202-10-118

Published: 22 September 2009



To date, functional imaging studies of treatment-induced recovery from chronic aphasia only assessed short-term treatment effects after intensive language training. In the present study, we show with functional magnetic resonance imaging (fMRI), that different brain regions may be involved in immediate versus long-term success of intensive language training in chronic post-stroke aphasia patients.


Eight patients were trained daily for three hours over a period of two weeks in naming of concrete objects. Prior to, immediately after, and eight months after training, patients overtly named trained and untrained objects during event-related fMRI. On average the patients improved from zero (at baseline) to 64.4% correct naming responses immediately after training, and treatment success remained highly stable at follow-up. Regression analyses showed that the degree of short-term treatment success was predicted by increased activity (compared to the pretraining scan) bilaterally in the hippocampal formation, the right precuneus and cingulate gyrus, and bilaterally in the fusiform gyri. A different picture emerged for long-term training success, which was best predicted by activity increases in the right-sided Wernicke's homologue and to a lesser degree in perilesional temporal areas.


The results show for the first time that treatment-induced language recovery in the chronic stage after stroke is a dynamic process. Initially, brain regions involved in memory encoding, attention, and multimodal integration mediated treatment success. In contrast, long-term treatment success was predicted mainly by activity increases in the so-called 'classical' language regions. The results suggest that besides perilesional and homologue language-associated regions, functional integrity of domain-unspecific memory structures may be a prerequisite for successful (intensive) language interventions.