Orientador: Rosana do Carmo Novaes Pinto / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-13T12:43:32Z (GMT). No. of bitstreams: 1 Canoas-Andrade_Rosangela_M.pdf: 2122155 bytes, checksum: e41f3e8059727d732ec7dd6d0bd9d6f8 (MD5) Previous issue date: 2009 / Resumo: A Fonoaudiologia tradicional, com relação às alterações da linguagem, ainda sofre a forte influência teórica e metodológica dos discursos que circulam na área médica. As abordagens orgânicas são geralmente priorizadas, em detrimento de análises mais abrangentes dos fenômenos e, principalmente, dos sujeitos. Essa visão redutora, inevitavelmente, também é que vai dar as diretrizes para o acompanhamento terapêutico. Orientado pela abordagem teórica e metodológica da Neurolingüística Discursiva (ND), este trabalho apresenta um estudo longitudinal de um caso de Afasia Fluente Progressiva, para o qual contribuem o histórico neurológico - constituído por imagens tomográficas e laudos que revelam lesões em várias áreas cerebrais, em decorrência de AVCs focais e isquêmicos, clipagem de aneurismas e atrofias corticais e sub-corticais, além dos resultados de avaliações neuropsicológicas e as análises lingüísticas de episódios dialógicos. Os dados analisados foram obtidos em episódios dialógicos ocorridos nas sessões semanais do Grupo III do CCA (Centro de Convivência de Afásicos) e em sessões individuais de acompanhamento fonoaudiológico, durante as quais também foram desenvolvidas algumas atividades metalingüísticas, com o objetivo de respaldar nossas hipóteses sobre suas dificuldades lingüísticas e cognitivas. Trata-se de um caso que consideramos singular, pois revela os efeitos das práticas sociais e do exercício real com a linguagem, tanto no curso do desenvolvimento de sua afasia, como das alterações cognitivas. A instabilidade presente no caso de AJ, cujos enunciados às vezes em nada diferem da normalidade, outras vezes revelam dificuldades próprias de sua afasia e, em determinados momentos assemelham-se aos quadros iniciais de demência, contribui para a reflexão acerca da relação normal/patológico.Por fim, discute-se o impacto da abordagem da ND para a clínica fonoaudiológica, na avaliação da linguagem e, principalmente, no acompanhamento terapêutico de sujeitos afásicos ou com outras alterações lingüísticas e cognitivas / Abstract: The traditional Speech Therapy, when the focus is language alterations, is still strongly influenced by the theoretical and methodological discourses from the medical field. Organic approaches are usually privileged in comparison to other approaches, other possibilities of analysis of the phenomena and, especially, of the subjects. This reductionist view, inevitably, is the one that will provide the guidelines for language therapy. Guided by the theoretical and methodological approach of Discursive Neurolinguistics (ND), this research presents a longitudinal study of a case of Fluent Progressive Aphasia. We present the neurological history of the case - which consists of tomography images and reports, which reveal lesions in various brain areas, due to strokes - focal and ischemic, clipping of aneurysms and cortical & sub-cortical atrophies. We also present the results of neuropsychological assessments and the analysis of linguistic episodes. Data were obtained during episodes occurred in the weekly discussion of Group III of CCA (Centro de Convivência de Afásicos) and in individual sessions of speech therapy, during which some metalinguistic activities were developed, with the aim of supporting our hypothesis about his linguistic and cognitive difficulties. This is a case that we consider unique, because it shows the effects of social and linguistic practices on the development of aphasia and on the cognitive changes. The instability that characterizes the case contributes to the debate / Mestrado / Linguistica / Mestre em Linguística

For two decades, researchers and clinicians have been using the diagnostic criteria for FTD to generally diagnose a patient as suffering from PPA and the criteria of Neary et al. (1998) to further specify the diagnosis as progressive nonfluent aphasia or semantic dementia. However, there were a number of PPA cases that could not be classified according to the criteria of Neary and colleagues, which led to a revision of the diagnostic clinical and research criteria for PPA by Gorno-Tempini et al. (2011). The revised criteria encompass three PPA variants (svPPA, nfvPPA, and lvPPA) with three stages characterized by increasing evidence: clinical diagnosis, imaging-supported diagnosis, and diagnosis with definite pathology. As compared to the previous diagnostic criteria, more emphasis is placed on imaging markers as supportive features. These imaging criteria were however proposed based on a purely qualitative evaluation of the literature and have not been validated so far. The aim of this thesis was to quantitatively evaluate the validity of the new diagnostic imaging criteria for PPA variants using anatomical likelihood meta-analyses (study 1) and to investigate the usefulness of these imaging criteria for the individual diagnosis of PPA patients in clinical routine using support vector machine classification (study 2).

Introdução: No Brasil há carência de instrumentos validados para a análise do curso da Demência Frontotemporal (DFT). Dessa forma, torna-se relevante a validação da Escala de Estadiamento e Progressão da Demência Frontotemporal (FTD-FRS). Em nosso meio, as escalas de estadiamento das demências, como a Clinical Dementia Rating (CDR), foram elaboradas para graduar a doença de Alzheimer (DA) e não incluem os sintomas específicos da DFT. Objetivos: 1. Realizar a tradução, adaptação transcultural e validação da FTD-FRS para o contexto brasileiro. 2. Avaliar a capacidade da FTD-FRS detectar alterações em pacientes com DFTvc, afasia progressiva primária (APP) e DA após 12 meses da avaliação inicial, em comparação com a escala CDR para DLFT, e com a CDR original. Métodos: Participaram do estudo 101 indivíduos com idade igual ou superior a 40 anos, com escolaridade formal acima de dois anos, sendo 31 pacientes com diagnóstico de DFT variante comportamental (DFTvc), doze pacientes com afasia progressiva primária (APP), 28 pacientes com doença de Alzheimer (DA), oito com comprometimento cognitivo leve (CCL) e 22 controles normais (CN). Foram entrevistados os familiares ou cuidadores que tinham contato frequente com o paciente. Os pacientes com DA, e com os subtipos de DFT foram pareados quanto à gravidade da doença, segundo a CDR. Resultados: Foi realizado o processo de adaptação transcultural da FTD-FRS. Consistiu em: tradução, retrotradução (realizadas por tradutores independentes), discussão com especialistas sobre a versão em português e equivalência com a versão original, e desenvolvimento da versão final. A consistência interna da FTD-FRS, estimada pelo alfa de Cronbach foi 0,975, e o coeficiente de correlação intra-classe, para a estabilidade no teste e reteste em seis meses foi de 0,977. A análise fatorial revelou a existência de quatro fatores que se correlacionaram significativamente com os domínios da CDR-DLFT. Os pacientes com DFTvc apresentaram progressão mais rápida em 12 meses do que os demais subtipos de demência na FTD-FRS, na CDR-DLFT e na CDR-original. Considerações finais: A FTD-FRS tem propriedades psicométricas adequadas para seu uso clínico no Brasil. Este instrumento pode auxiliar na caracterização de sintomas clínicos relevantes para o diagnóstico e estadiamento da DFT. Também pode documentar os resultados relacionados à intervenção terapêutica. Este estudo fornece aos clínicos e pesquisadores um instrumento válido para estadiamento e acompanhamentode de pacientes diagnosticados com DFT / Introduction: In Brazil there is a shortage of validated instruments for the analysis of the course of Frontotemporal Dementia (FTD). Thus, the validation of the Frontotemporal Dementia Staging and Progression Scale (FTD-FRS) becomes relevant. In our setting, dementia staging scales, such as the Clinical Dementia Rating (CDR), were designed to stage Alzheimer\'s disease (AD) and did not include the specific symptoms of FTD. Objectives: 1. To perform the translation, cross-cultural adaptation and validation of the FTD-FRS for the Brazilian context. 2. Evaluate the ability of the FTD-FRS to detect changes in patients with bvFTD, primary progressive aphasia (PPA) and AD after 12 months of the initial evaluation, compared to the CDR scale for FTLD, and with the original CDR. Methods: A total of 101 individuals aged 40 years and older, with formal schooling above two years of age, were included in the study. Twenty-one patients were diagnosed with bvFTD, twelve patients with PPA, 28 AD, eight with mild cognitive impairment (MCI) and 22 normal controls (NC). Family members or caregivers who had frequent contact with the patient were interviewed. Patients with AD and with FTD subtypes were matched for disease severity, according to CDR. Results: The process of cross-cultural adaptation of the FTD-FRS was carried out. It consisted of: translation, back-translation (carried out by independent translators), discussion with experts about the Portuguese version and equivalence with the original version, and development of the final version. The internal consistency of the FTD-FRS, estimated by the Cronbach\'s alpha was 0.975, and the intra-class correlation coefficient for the test and retest stability at six months was 0.977. Factor analysis revealed the existence of four factors that correlated significantly with the CDR-DLFT domains. Patients with bvFTD showed faster progression at 12 months than the other dementia subtypes in the FTD-FRS, CDR-DLFT and CDR-original version scales. Final considerations: FTD-FRS has psychometric properties suitable for clinical use in Brazil. This instrument may aid in the characterization of clinical symptoms relevant to the diagnosis and staging of FTD. It can also document the results related to therapeutic interventions. This study provides clinicians and researchers with a valid instrument for staging and follow-up of patients diagnosed with FTD

No description available.

No description available.

Introdução: No Brasil há carência de instrumentos validados para a análise do curso da Demência Frontotemporal (DFT). Dessa forma, torna-se relevante a validação da Escala de Estadiamento e Progressão da Demência Frontotemporal (FTD-FRS). Em nosso meio, as escalas de estadiamento das demências, como a Clinical Dementia Rating (CDR), foram elaboradas para graduar a doença de Alzheimer (DA) e não incluem os sintomas específicos da DFT. Objetivos: 1. Realizar a tradução, adaptação transcultural e validação da FTD-FRS para o contexto brasileiro. 2. Avaliar a capacidade da FTD-FRS detectar alterações em pacientes com DFTvc, afasia progressiva primária (APP) e DA após 12 meses da avaliação inicial, em comparação com a escala CDR para DLFT, e com a CDR original. Métodos: Participaram do estudo 101 indivíduos com idade igual ou superior a 40 anos, com escolaridade formal acima de dois anos, sendo 31 pacientes com diagnóstico de DFT variante comportamental (DFTvc), doze pacientes com afasia progressiva primária (APP), 28 pacientes com doença de Alzheimer (DA), oito com comprometimento cognitivo leve (CCL) e 22 controles normais (CN). Foram entrevistados os familiares ou cuidadores que tinham contato frequente com o paciente. Os pacientes com DA, e com os subtipos de DFT foram pareados quanto à gravidade da doença, segundo a CDR. Resultados: Foi realizado o processo de adaptação transcultural da FTD-FRS. Consistiu em: tradução, retrotradução (realizadas por tradutores independentes), discussão com especialistas sobre a versão em português e equivalência com a versão original, e desenvolvimento da versão final. A consistência interna da FTD-FRS, estimada pelo alfa de Cronbach foi 0,975, e o coeficiente de correlação intra-classe, para a estabilidade no teste e reteste em seis meses foi de 0,977. A análise fatorial revelou a existência de quatro fatores que se correlacionaram significativamente com os domínios da CDR-DLFT. Os pacientes com DFTvc apresentaram progressão mais rápida em 12 meses do que os demais subtipos de demência na FTD-FRS, na CDR-DLFT e na CDR-original. Considerações finais: A FTD-FRS tem propriedades psicométricas adequadas para seu uso clínico no Brasil. Este instrumento pode auxiliar na caracterização de sintomas clínicos relevantes para o diagnóstico e estadiamento da DFT. Também pode documentar os resultados relacionados à intervenção terapêutica. Este estudo fornece aos clínicos e pesquisadores um instrumento válido para estadiamento e acompanhamentode de pacientes diagnosticados com DFT / Introduction: In Brazil there is a shortage of validated instruments for the analysis of the course of Frontotemporal Dementia (FTD). Thus, the validation of the Frontotemporal Dementia Staging and Progression Scale (FTD-FRS) becomes relevant. In our setting, dementia staging scales, such as the Clinical Dementia Rating (CDR), were designed to stage Alzheimer\'s disease (AD) and did not include the specific symptoms of FTD. Objectives: 1. To perform the translation, cross-cultural adaptation and validation of the FTD-FRS for the Brazilian context. 2. Evaluate the ability of the FTD-FRS to detect changes in patients with bvFTD, primary progressive aphasia (PPA) and AD after 12 months of the initial evaluation, compared to the CDR scale for FTLD, and with the original CDR. Methods: A total of 101 individuals aged 40 years and older, with formal schooling above two years of age, were included in the study. Twenty-one patients were diagnosed with bvFTD, twelve patients with PPA, 28 AD, eight with mild cognitive impairment (MCI) and 22 normal controls (NC). Family members or caregivers who had frequent contact with the patient were interviewed. Patients with AD and with FTD subtypes were matched for disease severity, according to CDR. Results: The process of cross-cultural adaptation of the FTD-FRS was carried out. It consisted of: translation, back-translation (carried out by independent translators), discussion with experts about the Portuguese version and equivalence with the original version, and development of the final version. The internal consistency of the FTD-FRS, estimated by the Cronbach\'s alpha was 0.975, and the intra-class correlation coefficient for the test and retest stability at six months was 0.977. Factor analysis revealed the existence of four factors that correlated significantly with the CDR-DLFT domains. Patients with bvFTD showed faster progression at 12 months than the other dementia subtypes in the FTD-FRS, CDR-DLFT and CDR-original version scales. Final considerations: FTD-FRS has psychometric properties suitable for clinical use in Brazil. This instrument may aid in the characterization of clinical symptoms relevant to the diagnosis and staging of FTD. It can also document the results related to therapeutic interventions. This study provides clinicians and researchers with a valid instrument for staging and follow-up of patients diagnosed with FTD

La maladie d’Alzheimer (MA) et les aphasies progressives primaires (APP) s’accompagnent de perturbations du langage expressif parfois subtiles, mais précoces dans l’évolution de ces maladies neurodégénératives. Considérés dans une approche automatisée, ces changements pourraient constituer des marqueurs de dégénérescence identifiés de façon non invasive et peu onéreuse. À ce titre, ils font l’objet d’études visant à automatiser leur utilisation clinique. Cependant, l’intégration des marqueurs langagiers à une approche diagnostique centrée sur les biomarqueurs reste à faire. À cette fin, la présente thèse a deux objectifs. D’abord, recenser systématiquement les marqueurs du discours qui distinguent le mieux les personnes avec une MA de témoins en santé. Ensuite, appliquer une approche automatisée et à un large éventail de marqueurs de discours pour identifier, dans un groupe hétérogène de patients avec une APP, lesquels ont une pathologie Alzheimer sous-jacente. Afin de mettre en contexte ces deux objectifs, nous proposons une introduction générale comprenant les éléments suivants : la pathophysiologie de la MA et des APP, le rôle croissant des biomarqueurs dans la prise de décision clinique dans les maladies neurodégénératives, les études pionnières du discours en neurodégénérescence, ainsi que de récentes études computationnelles sur les marqueurs de discours dans la MA et les APP. Nos résultats font émerger un patron multidimensionnel (acoustique, lexical, syntaxique, sémantique et pragmatique) de changements langagiers qui distinguent les personnes avec une MA de témoins en santé, avec une prépondérance des marqueurs lexicosémantiques. Dans le groupe de patients avec une APP avec une imagerie amyloïde positive ou négative, nous mesurons ensuite le pouvoir de classification d’un court échantillon de discours et montrons qu’il peut être avantageusement comparé à d’autres biomarqueurs. Nous discutons du patron spécifique de marqueurs discriminants pour ce sous-groupe de patients, notamment l’importance des marqueurs psycholinguistiques pour prédire le résultat de l’imagerie amyloïde à partir du discours. / Alzheimer’s disease (AD) and primary progressive aphasias (PPA) feature changes in expressive language that appear early in the course of the disease. Within an automated analysis framework, these language changes could offer a non-invasive and inexpensive alternative to the collection of biomarkers which are not readily available in most settings. Current research is thus focused on the automated analysis of language data for clinical use. The usefulness of connected speech (CS) markers has not yet been established in a diagnostic perspective focused on biomarkers. To this aim, the present thesis contains two phases. First, we systematically review the CS markers that best differentiate persons with AD from healthy controls. Second, we automatically extract a wide array of CS markers in a heterogenous group of PPA patients by combining expert knowledge and the latest natural language processing software. A machine-learning classification approach identifies PPA patients for the presence of underlying AD pathology. The most discriminant CS features are identified. To integrate the two phases of the thesis, we provide a general introduction with the following sections: the pathophysiology of AD and PPAs, the growing importance of biomarkers in clinical decision-making for neurodegenerative diseases, the seminal studies of CS in neurodegenerative diseases, and the latest computational studies of CS markers in AD and PPA. Our results bring forth a multidimensional pattern (acoustic, lexical, syntactic, semantic, pragmatic) of language changes that distinguish people with AD from healthy controls, with an emphasis on lexical-semantic features. In the group of PPA patients with either positive or negative amyloid imaging, we then describe the classificatory power of a short sample of CS and show that it compares favorably to other biomarkers. We discuss the specific pattern of discriminant markers for this subgroup of patients, in particular the role of psycholinguistics.

L’aphasie est un trouble acquis du langage entraînant des problèmes de communication pouvant toucher la compréhension et/ou l’expression. Lorsque l’aphasie fait suite à un accident vasculaire cérébral, une régression des déficits communicatifs s'observe initialement, mais elle peut demeurer sévère pour certains et est considérée chronique après un an. Par ailleurs, l’aphasie peut aussi être observée dans l’aphasie progressive primaire, une maladie dégénérative affectant uniquement le langage dans les premières années. Un nombre grandissant d’études s’intéressent à l’impact de la thérapie dans l’aphasie chronique et ont démontré des améliorations langagières après plusieurs années. L’hémisphère gauche semble avoir un rôle crucial et est associé à de meilleures améliorations langagières, mais la compréhension des mécanismes de plasticité cérébrale est encore embryonnaire. Or, l’efficacité de la thérapie dans l’aphasie progressive primaire est peu étudiée. À l’aide de la résonance magnétique fonctionnelle, le but des présentes études consiste à examiner les mécanismes de plasticité cérébrale induits par la thérapie Semantic Feature Analysis auprès de dix personnes souffrant d’aphasie chronique et d’une personne souffrant d’aphasie progressive primaire. Les résultats suggèrent que le cerveau peut se réorganiser plusieurs années après une lésion cérébrale ainsi que dans une maladie dégénérative. Au niveau individuel, une meilleure amélioration langagière est associée au recrutement de l’hémisphère gauche ainsi qu’une concentration des activations. Les analyses de groupe mettent en évidence le recrutement du lobule pariétal inférieur gauche, alors que l’activation du gyrus précentral gauche prédit l’amélioration suite à la thérapie. D’autre part, les analyses de connectivité fonctionnelle ont permis d’identifier pour la première fois le réseau par défaut dans l’aphasie. Suite à la thérapie, l’intégration de ce réseau bien connu est comparable à celle des contrôles et les analyses de corrélation suggèrent que l’intégration du réseau par défaut a une valeur prédictive d’amélioration. Donc, les résultats de ces études appuient l’idée que l’hémisphère gauche a un rôle prépondérant dans la récupération de l’aphasie et fournissent des données probantes sur la neuroplasticité induite par une thérapie spécifique du langage dans l’aphasie. De plus, l’identification d’aires clés et de réseaux guideront de futures recherches afin d’éventuellement maximiser la récupération de l’aphasie et permettre de mieux prédire le pronostic. / Aphasia is an acquired language impairment leading to communication disorders which may affect comprehension and/or expression. When aphasia follows a stroke, major recovery of the communicative deficits is initially observed after the lesion, but for some the aphasia may remain severe and is considered to be chronic after a year. Furthermore aphasia can be observed in primary progressive aphasia, a degenerative disease only affecting language in the early years. The impact of therapy in chronic aphasia is the subject of growing literature in recent years and has shown language improvements after several years of therapy. The left hemisphere seems to have a crucial role and is associated with greater language improvements but our understanding of brain plasticity mechanisms is still lacking. In primary progressive aphasia, few studies have examined therapy effectiveness. Using functional magnetic resonance imaging, the aim of these studies was to examine therapy-induced brain plasticity mechanisms following Semantic Feature Analysis in ten participants suffering from chronic aphasia and one participant with primary progressive aphasia. The results suggest that brain reorganization is possible several years after injury and in degenerative disease. At the individual level, greater language improvement is associated with the recruitment of the left hemisphere and less activated areas. Group analysis shows the recruitment of left inferior parietal lobule, whereas the activation of left precentral gyrus predicts improved response to therapy. Functional connectivity analysis allowed for the first time the identification of the default-mode network in aphasia. Following therapy, the integration of this well-known network is comparable to that of the controls and the correlation analysis suggests that the default-mode network integration has a predictive value for improvement. Therefore, the results of these studies support the idea that the left hemisphere has a major role in the recovery of aphasia and provide evidence on therapy-induced neuroplasticity in aphasia. In addition, the identification of key areas and networks will guide future research in order to possibly maximize the recovery of aphasia and to better predict the prognosis.

L’aphasie est un trouble acquis du langage entraînant des problèmes de communication pouvant toucher la compréhension et/ou l’expression. Lorsque l’aphasie fait suite à un accident vasculaire cérébral, une régression des déficits communicatifs s'observe initialement, mais elle peut demeurer sévère pour certains et est considérée chronique après un an. Par ailleurs, l’aphasie peut aussi être observée dans l’aphasie progressive primaire, une maladie dégénérative affectant uniquement le langage dans les premières années. Un nombre grandissant d’études s’intéressent à l’impact de la thérapie dans l’aphasie chronique et ont démontré des améliorations langagières après plusieurs années. L’hémisphère gauche semble avoir un rôle crucial et est associé à de meilleures améliorations langagières, mais la compréhension des mécanismes de plasticité cérébrale est encore embryonnaire. Or, l’efficacité de la thérapie dans l’aphasie progressive primaire est peu étudiée. À l’aide de la résonance magnétique fonctionnelle, le but des présentes études consiste à examiner les mécanismes de plasticité cérébrale induits par la thérapie Semantic Feature Analysis auprès de dix personnes souffrant d’aphasie chronique et d’une personne souffrant d’aphasie progressive primaire. Les résultats suggèrent que le cerveau peut se réorganiser plusieurs années après une lésion cérébrale ainsi que dans une maladie dégénérative. Au niveau individuel, une meilleure amélioration langagière est associée au recrutement de l’hémisphère gauche ainsi qu’une concentration des activations. Les analyses de groupe mettent en évidence le recrutement du lobule pariétal inférieur gauche, alors que l’activation du gyrus précentral gauche prédit l’amélioration suite à la thérapie. D’autre part, les analyses de connectivité fonctionnelle ont permis d’identifier pour la première fois le réseau par défaut dans l’aphasie. Suite à la thérapie, l’intégration de ce réseau bien connu est comparable à celle des contrôles et les analyses de corrélation suggèrent que l’intégration du réseau par défaut a une valeur prédictive d’amélioration. Donc, les résultats de ces études appuient l’idée que l’hémisphère gauche a un rôle prépondérant dans la récupération de l’aphasie et fournissent des données probantes sur la neuroplasticité induite par une thérapie spécifique du langage dans l’aphasie. De plus, l’identification d’aires clés et de réseaux guideront de futures recherches afin d’éventuellement maximiser la récupération de l’aphasie et permettre de mieux prédire le pronostic. / Aphasia is an acquired language impairment leading to communication disorders which may affect comprehension and/or expression. When aphasia follows a stroke, major recovery of the communicative deficits is initially observed after the lesion, but for some the aphasia may remain severe and is considered to be chronic after a year. Furthermore aphasia can be observed in primary progressive aphasia, a degenerative disease only affecting language in the early years. The impact of therapy in chronic aphasia is the subject of growing literature in recent years and has shown language improvements after several years of therapy. The left hemisphere seems to have a crucial role and is associated with greater language improvements but our understanding of brain plasticity mechanisms is still lacking. In primary progressive aphasia, few studies have examined therapy effectiveness. Using functional magnetic resonance imaging, the aim of these studies was to examine therapy-induced brain plasticity mechanisms following Semantic Feature Analysis in ten participants suffering from chronic aphasia and one participant with primary progressive aphasia. The results suggest that brain reorganization is possible several years after injury and in degenerative disease. At the individual level, greater language improvement is associated with the recruitment of the left hemisphere and less activated areas. Group analysis shows the recruitment of left inferior parietal lobule, whereas the activation of left precentral gyrus predicts improved response to therapy. Functional connectivity analysis allowed for the first time the identification of the default-mode network in aphasia. Following therapy, the integration of this well-known network is comparable to that of the controls and the correlation analysis suggests that the default-mode network integration has a predictive value for improvement. Therefore, the results of these studies support the idea that the left hemisphere has a major role in the recovery of aphasia and provide evidence on therapy-induced neuroplasticity in aphasia. In addition, the identification of key areas and networks will guide future research in order to possibly maximize the recovery of aphasia and to better predict the prognosis.