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Predicting language outcome and recovery after stroke: the PLORAS system

Nature Reviews Neurology volume 6, pages 202–210 (2010)Cite this article

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Abstract

The ability to comprehend and produce speech after stroke depends on whether the areas of the brain that support language have been damaged. Here, we review two different ways to predict language outcome after stroke. The first depends on understanding the neural circuits that support language. This model-based approach is a challenging endeavor because language is a complex cognitive function that involves the interaction of many different brain areas. The second approach, by contrast, does not require an understanding of why a lesion impairs language; instead, predictions are made on the basis of the recovery of previous patients with the same lesion. This approach requires a database that records the speech and language capabilities of a large population of patients who have, collectively, incurred a comprehensive range of focal brain lesions. In addition, a system is required that converts an MRI scan from a new patient into a three-dimensional description of the lesion and compares this lesion against all others on the database. The outputs of this system are the longitudinal language outcomes of corresponding patients in the database. This approach will provide the patient with a range of probable recovery patterns over a variety of language measures.

Key Points

  • Currently, no method exists to accurately predict recovery from aphasia after stroke

  • Many factors influence recovery, but the main determinant is lesion site

  • We introduce a new system, PLORAS (Predicting Language Outcome and Recovery After Stroke), to predict language outcome on the basis of lesion site

  • Predictive validity of this system will depend on collaborative efforts to develop an international database

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Figure 1: Brain activation during speech processing and predicted effects of lesions.
Figure 2: Procedures and database needed to estimate recovery of language after brain damage.

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  1. Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London, WC1N 3BG, UK

    Cathy J. Price, Mohamed L. Seghier & Alex P. Leff

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Price, C., Seghier, M. & Leff, A. Predicting language outcome and recovery after stroke: the PLORAS system. Nat Rev Neurol 6, 202–210 (2010). https://doi.org/10.1038/nrneurol.2010.15

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