Journal

The Japanese journal of neuropsychology

[Vol.21 No.1 contents]
Japanese/English

Full Text of this Article
in Japanese PDF (89K)
ArticleTitle Stages and Mechanisms of Recovery from Aphasia
Language J
AuthorList Argye E. Hillis
Affiliation Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins University Department of Cognitive Science
Publication Japanese Journal of Neuropsychology: 21 (1), 35-43, 2005
Received
Accepted
Abstract Most individuals with aphasia due to stroke recover language skills, at least to some extent, over time. In this paper I review evidence that aphasia recovery takes place in at least three overlapping stages with different neural mechanisms of recovery in each stage. In the acute stage (the first few hours or days after stroke), the main mechanism of recovery is restoration of tissue function, primarily by improved blood flow to dysfunctional brain regions. In the intermediate stage (weeks to months after stroke), the primary mechanism of language recovery is reorganization of structure/function relationships, in which nearby (perilesional) brain regions or homologous regions in the opposite hemisphere assume the functions of the damaged brain regions. In the late stage (months to many years after stroke), the primary mechanism of recovery is through learning new pathways to access previously known representations or through learning compensatory strategies. I propose that different forms of speech and language therapy, possibly augmented with medications, are differentially beneficial at each stage. In the acute stage, the clinician may be most helpful by providing hope, information about aphasia and counseling caregivers regarding how to best communicate with the individual. Tissue recovery may be facilitated by mediations that improve cerebral blood flow. At the intermediate stage, the clinician may be most helpful by providing therapies that stimulate reorganization with intensive facilitation and practice in affected language skills. Stimulation therapy can be facilitated by medications that augment synaptic plasticity (through long-term potentiation). In the late stage, the clinician needs to employ creative means to assist the aphasic individual in discovering new ways to access language representations and to develop new ways to communicate to compensate for impaired skills. At this stage, antidepressant medications can be helpful if indicated, but the main focus should be on innovative and individualized therapy to maximize functional communication.
Keywords aphasia, recovery, rehabilitation, stroke, MRI

Copyright © 2002 NEUROPSYCHOLOGY ASSOCIATION OF JAPAN All rights reserved
http://www.neuropsychology.gr.jp/