MUSC part of $11.1M NIH aphasia study to help stroke patients

Margaret Lesesne’s kids call her “Hummer Mama.” Yes, the 85-year-old sports fan and regular churchgoer has a Hummer she calls “her baby.” But it’s parked these days while Lesesne recovers from a stroke at the Medical University of South Carolina.

On a recent afternoon, MUSC speech pathologist Katie Murphy tried to get Lesesne to say simple words like “ladder.” Lesesne, a stroke survivor, gradually is getting better at responding to Murphy.

"You want to stop for now?” Murphy asked as Lesesne closed her eyes during their session. The answer was no. Lesesne’s eyes reopened. The “Hummer Mama” wanted to keep rolling. 

Doctors at MUSC are about to take part in a large study designed to help people such as Lesesne by determining the best treatment options and figuring out which stroke patients are most likely to recover from communication problems. It’s funded by an $11.1 million award from the National Institutes of Health.

More than one-third of the people who have strokes suffer from aphasia, a condition caused by a brain injury that affects a person’s ability to speak, write, read and understand language. The grant, from the NIH’s National Institute on Deafness and Other Communication Disorders, will create the Center for the Study of Aphasia Recovery at the University of South Carolina.

The research, led by Julius Fridriksson, Ph.D. at USC, will include work not only out of MUSC but also Johns Hopkins University and the University of California Irvine.

Leonardo Bonilha, M.D., Ph.D., an associate professor of neurology at MUSC, and Jordan Elm, Ph.D., a biostatistician and research associate professor at MUSC, are co-site primary investigators for the MUSC part of the study. Bonilha said this research will help answer some key questions.

“This project has tremendous potential to help doctors and scientists better understand how the brain produces language and how someone can recover their language functions after a brain injury, particularly after a stroke.”

Bonilha will coordinate patient identification and recruitment at MUSC. Elm will do statistical analyses. “We will be responsible for creating the study database, ensuring there are no logical inconsistencies in the data that’s collected and no data is missing,” Elm said.

Bonilha said MUSC’s Language and Aphasia Clinic takes a multidisciplinary approach, combining the services of neurology and speech pathology. “Its purpose is to diagnose and treat language disorders and aphasia.”

That’s why Bonilha and colleagues are excited to be a part of the grant that promises to shed light on newer and more effective treatment methods.

Fridriksson, a professor in the Arnold School of Public Health, studies how a person’s brain recovers from a stroke, with particular attention to how stroke affects communication. While technology and treatment have significantly improved a person’s ability to survive a stroke, there is much work to be done to help those who suffer from communication issues in the months and years afterward, he said.

“The need is very great. In the U.S., about 1 million people have aphasia. We haven’t done a very good job of helping them cope with a very difficult situation. When you can’t speak and comprehend very well that makes for a very difficult life," Fridriksson said. "We need to do a lot better in helping them deal with that situation and helping them recover better.”

The need is particularly high in South Carolina, a state with the seventh highest stroke death rate in the nation in 2014. It is part of the “Stroke Belt,” a group of Southeastern states with high stroke death rates.

Fridriksson’s work relies heavily on detailed pictures of the brains of stroke patients made at the MRI scanner at the McCausland Center for Brain Imaging. Those pictures show blood flow and functional activity of the brain, allowing researchers to understand changes and workings of the brain related to stroke and recovery. The grant will be used to research and better understand individual responses and recovery following stroke for patients who have aphasia in both the first days and weeks after a stroke, and in long-term recovery.

Fridriksson hopes the research findings will have national and international implications for stroke patients’ treatment. “The study we are about to take on, once we finish it, is going to be the largest study of aphasia recovery in the past couple of decades,” said Fridriksson, who has been working on aphasia research since joining the Arnold School 15 years ago.

“What we’re trying to do here is to get a big data approach to understanding recovery. That doesn’t happen unless you get a lot of patients to come in and receive therapy.”

The grant will allow work on four major projects:

• Working with chronic patients, assessing a patient’s neurophysiology before starting treatment, providing behavioral treatment and trying to predict who will respond well or poorly to treatment.
• Assessing patients who have just had a stroke, providing aphasia therapy and electrical brain stimulation, which is believed to improve the environment for recovery in the brain. The goal is to understand the best ways to enhance the outcome in patients in the days and weeks following a stroke.
• Building a computationally heavy model of who is most likely to recover and who is not, based on neuropsychological and neurological factors of patients.
• Conducting a theoretically-based study that looks at neuropsychological models of speech and language in normal people and then relating those to recovery in patients.

“One of the first things we want to know is why is there such variance in who responds to treatment,” Fridriksson said. “It’s something that we know very little about.”

Fridriksson said stroke survivors have specific questions regarding their recovery, ones that lead to anxiety and depression if left unanswered. “For a while we were only able to look at the amount of damage the stroke caused for patients. Now we know that there are other factors that influence recovery, but we don’t know which ones matter most or what roles they play.”

One of the primary factors the center will look at to predict prognosis is brain fitness, an umbrella term that includes many different measures of brain integrity such as residual cerebral blood flow, intactness of brain connections and location and size of brain damage. Researchers will also assess variables such as age, time-post stroke, gender and neuropsychological status.

“Previous research has yielded small data samples that often lead to more questions than answers,” Fridriksson said. He said the new center could revolutionize treatment for aphasia patients by collecting and analyzing data from hundreds of people through collaborations among the center’s four sites.