Neurologists and aphasiologists have debated for over a century whether right hemisphere recruitment facilitates or impedes recovery from aphasia. Here we present a well-characterized patient with sequential left and right hemisphere strokes whose case substantially informs this debate. A 72-year-old woman with chronic nonfluent aphasia was enrolled in a trial of transcranial magnetic stimulation (TMS). She underwent 10 daily sessions of inhibitory TMS to the right pars triangularis. Brain activity was measured during picture naming using fMRI prior to TMS exposure and before and after TMS on the first day of treatment. Language and cognition were tested behaviorally three times prior to treatment, and at 2 and 6 months afterwards. Inhibitory TMS to the right pars triangularis induced immediate improvement in naming, which was sustained 2 months later. FMRI confirmed a local reduction in activity at the TMS target, without expected increased activity in corresponding left hemisphere areas. Three months after TMS, the patient suffered a right hemisphere ischemic stroke, resulting in worsening of aphasia without other clinical deficits. Behavioral testing 3 months later confirmed that language function was impacted more than other cognitive domains. The paradoxical effects of inhibitory TMS and the stroke to the right hemisphere demonstrate that even within a single patient, involvement of some right hemisphere areas may support recovery, while others interfere. The behavioral evidence confirms that compensatory reorganization occurred within the right hemisphere after the original stroke. No support is found for interhemispheric inhibition, the theoretical framework on which most therapeutic brain stimulation protocols for aphasia are based.
aphasia; transcranial magnetic stimulation; plasticity; neuromodulation; interhemispheric inhibition
While converging evidence implicates the right inferior parietal lobule in audiovisual integration, its role has not been fully elucidated by direct manipulation of cortical activity. Replicating and extending an experiment initially reported by Kamke et al. (2012), we employed the sound-induced flash illusion, in which a single visual flash, when accompanied by two auditory tones, is misperceived as multiple flashes (Wilson, 1987; Shams et al., 2000). Slow repetitive (1 Hz) TMS administered to the right angular gyrus, but not the right supramarginal gyrus, induced a transient decrease in the Peak Perceived Flashes (PPF), reflecting reduced susceptibility to the illusion. This finding independently confirms that perturbation of networks involved in multisensory integration can result in a more veridical representation of asynchronous auditory and visual events and that cross-modal integration is an active process in which the objective is the identification of a meaningful constellation of inputs, at times at the expense of accuracy.
transcranial magnetic stimulation; noninvasive brain stimulation; sound-induced flash illusion; audiovisual integration; inferior parietal lobule (IPL); angular gyrus (AG)
Loss of fluency is a significant source of functional impairment in many individuals with aphasia. Repetitive transcranial magnetic stimulation (rTMS) administered to the right inferior frontal gyrus (IFG) has been shown to facilitate naming in persons with chronic left hemisphere stroke and non-fluent aphasia. However, changes in fluency in aphasic subjects receiving rTMS have not been adequately explored.
To determine whether rTMS improves fluency in individuals with chronic nonfluent aphasia, and to identify aspects of fluency that are modulated in persons who respond to rTMS.
Methods & Procedures
Ten individuals with left hemisphere MCA strokes and mild to moderate non-fluent aphasia participated in the study. Before treatment, subjects were asked to describe the Cookie Theft picture in three separate sessions. During treatment, all subjects received 1200 pulses of 1 Hz rTMS daily in 10 sessions over two weeks at a site that had previously been shown to improve naming. Subjects repeated the Cookie Theft description two months after treatment. Five subjects initially received sham stimulation instead of real TMS. Two months after sham treatment, these individuals received real rTMS. Performance both at baseline and after stimulation was coded using Quantitative Production Analysis (Saffran, Berndt & Schwartz, 1989) and Correct Information Unit (Nicholas & Brookshire, 1993) analysis.
Outcomes & Results
Across all subjects (n=10), real rTMS treatment resulted in a significant increase in multiple measures of discourse productivity compared to baseline performance. There was no significant increase in measures of sentence productivity or grammatical accuracy. There was no significant increase from baseline in the sham condition (n=5) on any study measures.
Stimulation of the right IFG in patients with chronic non-fluent aphasia facilitates discourse production. We posit that this effect may be attributable to improved lexical-semantic access.
Language; aphasia; TMS; pars triangularis; fluency; neurorehabilitation
Poor reading efficiency is the most persistent problem for adults with developmental dyslexia. Previous research has demonstrated a relationship between left posterior temporal cortex (pTC) function and reading ability, regardless of dyslexia status.
In this study, we tested whether enhancing left lateralization of pTC using transcranial direct current stimulation (tDCS) improves reading efficiency in adults without dyslexia.
Twenty-five right-handed adults with no history of learning disorder participated. Real and sham “Left lateralizing” tDCS were applied to the pTC in separate sessions. Standardized word and nonword reading tests were given immediately after stimulation.
Modeling of the induced electrical field confirmed that tDCS was likely to increase left pTC excitability and reduce right pTC excitability as intended. Relative to sham, real tDCS induced improvements in word reading efficiency in below average readers.
Enhancing left lateralization of the pTC using tDCS improves word reading efficiency in below-average readers. This demonstrates that left lateralization of the pTC plays a role in reading ability, and provides stimulation parameters that could be used for a trial of tDCS in adults with developmental dyslexia. Such short-term gains could amplify the effect of appropriate reading interventions when performed in conjunction with them.
dyslexia; alexia; language; reading fluency
This review of our research with rTMS to treat aphasia contains four parts: Part 1 reviews functional brain imaging studies related to recovery of language in aphasia with emphasis on nonfluent aphasia. Part 2 presents the rationale for using rTMS to treat nonfluent aphasia patients (based on results from functional imaging studies). Part 2 also reviews our current rTMS treatment protocol used with nonfluent aphasia patients, and our functional imaging results from overt naming fMRI scans, obtained pre- and post- a series of rTMS treatments. Part 3 presents results from a pilot study where rTMS treatments were followed immediately by constraint-induced language therapy (CILT). Part 4 reviews our diffusion tensor imaging (DTI) study that examined white matter connections between the horizontal, midportion of the arcuate fasciculus (hAF) to different parts within Broca’s area (pars triangularis, PTr; pars opercularis, POp), and the ventral premotor cortex (vPMC) in the RH and in the LH. Part 4 also addresses some of the possible mechanisms involved with improved naming and speech, following rTMS with nonfluent aphasia patients.
Mental motor imagery is subserved by the same cognitive systems that underlie action. In turn, action is informed by the anticipated sensory consequences of movement, including pain. In light of these considerations, one would predict that motor imagery would provide a useful measure pain-related functional interference. We report a study in which 19 patients with chronic musculoskeletal or radiculopathic arm or shoulder pain, 24 subjects with chronic pain not involving the arm/shoulder and 41 normal controls were asked to indicate if a line drawing was a right or left hand. Previous work demonstrated that this task is performed by mental rotation of the subject’s hand to match the stimulus. Relative to normal and pain control subjects, arm/shoulder pain subjects were significantly slower for stimuli that required greater amplitude rotations. For the arm/shoulder pain subjects only there was a correlation between degree of slowing and the rating of severity of pain with movement but not the non-specific pain rating. The hand laterality task may supplement the assessment of subjects with chronic arm/shoulder pain.
pain assessment; motor imagery; musculoskeletal pain
Previous research with deafferented subjects suggests that efference copy can be used to update limb position. However, the contributions of efference copy to limb localization are currently unclear. We examined the performance of JDY, a woman with severe, longstanding proprioceptive deficits from a sensory peripheral neuropathy, on a reaching task to explore the contribution of efference copy to trajectory control. JDY and eight healthy controls reached without visual feedback to a target that either remained stationary or jumped to a second location after movement initiation. JDY consistently made hypermetric movements to the final target, exhibiting significant problems with amplitude control. Despite this amplitude control deficit, JDY’s performance on jump trials showed that the angle of movement correction (angle between pre- and post-correction movement segments) was significantly correlated with the distance (but not time) of movement from start to turn point. These data suggest that despite an absence of proprioceptive and visual information regarding hand location, JDY derived information about movement distance that informed her movement correction on jump trials. The same type of information that permitted her to correct movement direction on-line, however, was not available for control of final arm position. We propose that efference copy can provide a consistent estimate of limb position that becomes less informative over the course of the movement. We discuss the implications of these data for current models of motor control.
deafferentation; efference copy; motor control; proprioception; reaching
Previous studies have suggested that contingent negative variation (CNV), as recorded by electroencaphalography (EEG), may serve as an index of temporal encoding. The interpretation of these studies is complicated by the fact that in a majority of studies the CNV signal was obtained at a time when subjects were not only registering stimulus duration but also making decisions and preparing to act. Previously, we demonstrated that repetitive transcranial magnetic stimulation (rTMS) of the right supramarginal gyrus (rSMG) in humans lengthened the perceived duration of a visual stimulus (Wiener, et al. 2010a), suggesting the rSMG is involved in basic encoding processes. Here, we report a replication of this effect with simultaneous EEG recordings during the encoding of stimulus duration. Stimulation of the rSMG led to an increase in perceived duration and the amplitude of N1 and CNV components recorded from frontocentral sites. Furthermore, the size of the CNV amplitude, but not N1, positively correlated with the size of the rTMS effect but negatively correlated with bias (the baseline tendency to report a comparison stimulus as shorter), suggesting that the CNV indexes stimulus duration. These results suggest that a feed-forward mechanism from parietal to prefrontal regions mediates temporal encoding, and demonstrate a dissociation between early and late phases of encoding processes.
Temporal Attention; Time Perception; Contingent Negative Variation; Transcranial; Magnetic Stimulation; Electroencephalography; Bias
Evidence from patients has shown that primary somatosensory representations are plastic, dynamically changing in response to central or peripheral alterations, as well as experience. Furthermore, recent research has also demonstrated that altering body posture results in changes in the perceived sensation and localization of tactile stimuli. Using evidence from behavioral studies with brain damaged and healthy subjects, as well as functional imaging, we propose that the traditional concept of the body schema should be divided into three components. First are primary somatosensory representations, which are representations of the skin surface that are typically somatotopically organized, and have been shown to change dynamically due to peripheral (usage, amputation, deafferentation) or central (lesion) modifications. Second, we argue for a mapping from a primary somatosensory representation to a secondary representation of body size and shape (body form representation). Finally, we review evidence for a third set of representations that encodes limb position and is used to represent the location of tactile stimuli relative to the subject using external, non-somatotopic reference frames (postural representations).
Debate continues regarding the mechanisms underlying covert shifts of visual attention. We examined the relationship between target eccentricity and the speed of covert shifts of attention in normal subjects and patients with brain lesions using a cued-response task in which cues and targets were presented at 2° or 8° lateral to the fixation point. Normal subjects were slower on invalid trials in the 8° as compared to 2° condition. Patients with right hemisphere stroke with neglect were slower in their responses to left-sided invalid targets compared to valid targets, and demonstrated a significant increase in the effect of target validity as a function of target eccentricity. Additional data from one neglect patient (JM) demonstrated an exaggerated validity × eccentricity × side interaction for contralesional targets on a cued reaction time task with a central (arrow) cue. We frame these results in the context of a continuous ‘moving spotlight’ model of attention, and also consider the potential role of spatial saliency maps. By either account, we argue that neglect is characterized by an eccentricity-dependent deficit in the allocation of attention.
neglect; disengage; attention; eccentricity; validity
Both feedforward and feedback mechanisms are used to ensure accurate movements. Feedback information comes primarily from vision and proprioception; the relative contributions of these modalities to on-line control of action and internal model maintenance remain unclear. We report data from an experiment in which a chronically deafferented subject (JDY) and nine controls were asked to reach to targets of different sizes both with and without vision. Movement times of controls were consistent with Fitts’ Law on trials with and without vision. JDY’s movement times were consistent with Fitts’ Law only with vision. She was inaccurate relative to controls with vision but exhibited a significantly greater decrement in performance than controls without vision. Finally, JDY’s performance on trials with vision deteriorated as a function of the number of preceding trials on which vision was not available. These data provide support for classical models of motor control that divide reaching into an initial ballistic movement guided by efference copy, and a terminal stage where sensory feedback is crucial. Furthermore, these data also demonstrate that proprioception is needed to calibrate and maintain internal models of action.
We report data from 31 subjects with focal hemisphere lesions (15 left hemisphere) as well as 16 normal controls on a battery of tasks assessing the estimation, production and reproduction of time intervals ranging from 2–12 seconds. Both visual and auditory stimuli were employed for the estimation and production tasks. First, ANOVAs were performed to assess the effect of stimulus modality on estimation and production tasks; a significant effect of stimulus modality was observed for the production but not the estimation task. Second, accuracy was significantly different for the 2 second interval as compared to longer intervals. Subsequent analyses of the data from 4–12 second stimuli demonstrated that patients with brain lesions were more variable than controls on the estimation and reproduction tasks. Additionally, patients with brain lesions but not controls exhibited significant differences in performance on the different tasks; patients with brain lesions under-produced but over-estimated time intervals of 4–12 seconds but performed relatively well on the reproduction task, a pattern of performance consistent with a “fast clock”. There was a significant correlation between impaired performance and lesions of the parietal lobe but there was no effect of laterality of lesion or correlation between lateral frontal lobe lesions and impairment on any task.
Cognitive timing; brain lesion; time estimation; time reproduction; time production
Previous research suggests that the frontal lobes are essential for temporal processing. We report a patient, MN, with probable Frontotemporal Dementia (FTD) who was tested on a battery of timing tasks with stimuli in the sub- and supra-second range. MN demonstrated a substantial over-estimation and under-production of target intervals on estimation and production tasks respectively but was as accurate as controls on a reproduction task. Furthermore, this deficit was markedly different for auditory and visual stimuli on production and estimation tasks; estimates of the duration of auditory stimuli were 3-4 times longer than for comparable visual stimuli. She performed normally on a task requiring her to judge whether a stimulus was longer or shorter than a standard duration with both sub- and supra-second stimuli. She performed well on control tasks involving estimation, production and reproduction of line lengths suggesting that her deficits were not attributable to a generalized cognitive impairment or an inability to make magnitude judgments. These data suggest that bifrontal pathology disrupts the “clock” or memory for time.
Temporal processing; interval timing; Frontotemporal dementia; 0THERS?
When confronted with two identical stimuli in a very brief period of time subjects often fail to report the second stimulus, a phenomenon termed “repetition blindness”. The “type-token” account attributes the phenomenon to a failure to individuate the exemplars. We report a subject, KE, who developed simultanagnosia (the inability to see more than one item in an array) as a consequence of bilateral parietal lobe infarctions. With presentation of two words, pictures or letters for an unlimited time, KE typically reported both stimuli on less than half of trials. Performance was significantly influenced by the semantic relationship between items in the array. He reported both items significantly more frequently if they were semantically related; in contrast, when presented either identical or visually different depictions of the same item, he reported both items on only 2-4% of trials. Performance was not influenced by the visual similarity between the stimuli; he reported visually dissimilar objects less frequently than visually similar but different objects. We suggest that KE's bilateral parietal lesions prevent the binding of preserved object representations to a representation computed by the dorsal visual system. More generally, these data are consistent with the claim that the posterior parietal cortex is crucial for individuating a stimulus by computing its unique spatio-temporal characteristics.
repetition blindness; parietal lobe; simultanagnosia; binding; visual attention
Semantic errors in aphasia (e.g., naming a horse as “dog”) frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were found in the left anterior temporal lobe (L-ATL), in the mid- to anterior MTG region. The absence of findings in Wernicke’s area was surprising, as were indications that ATL voxels made an essential contribution to the post-semantic stage of lexical access. In this follow-up study, we sought to validate these results by re-defining semantic errors in a manner that was less theory dependent and more consistent with prior lesion studies. As this change also increased the robustness of the dependent variable, it made it possible to perform additional statistical analyses that further refined the interpretation. The results strengthen the evidence for a causal relationship between ATL damage and lexically-based semantic errors in naming and lend confidence to the conclusion that chronic lesions in Wernicke’s area are not causally implicated in semantic error production.
aphasia; voxel-based lesion-symptom mapping; naming; semantic; errors
The Philadelphia Brief Assessment of the Cognition (PBAC) is a brief dementia-screening instrument. The PBAC assesses five cognitive domains: working memory/executive control; lexical retrieval/language; visuospatial/visuoconstructional operations; verbal/visual episodic memory; and behavior/social comportment. A revised version of the PBAC was administered to 198 participants including patients with Alzheimer’s disease (AD) (n=46) and four groups of patients with frontotemporal dementia (FTD) syndromes: behavioral-variant FTD (bvFTD; n=65), semantic-variant primary progressive aphasia (PPA) (svPPA; n=22), non-fluent/agrammatic-variant PPA (nfaPPA; n=23), and corticobasal syndrome (CBS; n=42), and a group of normal controls (n=15). The total PBAC score was highly correlated with the MMSE. The criterion validity of the PBAC was assessed relative to standard neuropsychological test performance. Using standard neuropsychological test performance as a criterion, the total PBAC score accurately identified the presence and severity of dementia. Intra-class correlations between PBAC subscales and standard neuropsychological tests were highly significant. PBAC subscales demonstrated good clinical utility in distinguishing AD and FTD subtypes using receiver operating characteristic analysis and standard diagnostic performance statistics to determine optimal subscale cut scores. The PBAC is a valid tool and able to assesses differential patterns neuropsychological/behavioral impairment in a broad range of neurodegenerative conditions.
Alzheimer’s disease; Frontotemporal lobar dementia; Frontotemporal dementia; FTD; Philadelphia Brief Assessment of the Cognition; PBAC; Neuropsychological assessment; Philadelphia (repeatable) Verbal Learning Test
Coull and Nobre (2008) suggested that tasks that employ temporal cues might be divided on the basis of whether these cues are explicitly or implicitly processed. Furthermore, they suggested that implicit timing preferentially engages the left cerebral hemisphere. We tested this hypothesis by conducting a quantitative meta-analysis of eleven neuroimaging studies of implicit timing using the activation-likelihood estimation (ALE) algorithm (Turkeltaub, et al. 2002). Our analysis revealed a single but robust cluster of activation-likelihood in the left inferior parietal cortex (supramarginal gyrus). This result is in accord with the hypothesis that the left hemisphere subserves implicit timing mechanisms. Furthermore, in conjunction with a previously reported meta-analysis of explicit timing tasks, our data support the claim that implicit and explicit timing are supported by at least partially distinct neural structures.
The role of the posterior parietal cortex in working memory (WM) is poorly understood. We previously found that patients with parietal lobe damage exhibited a selective WM impairment on recognition but not recall tasks. We hypothesized that this dissociation reflected strategic differences in the utilization of attention. One concern was that these findings, and our subsequent interpretation, would not generalize to normal populations because of the patients older age, progressive disease processes, and/or possible brain reorganization following injury. To test whether our findings extended to a normal population we applied transcranial direct current stimulation (tDCS) to right inferior parietal cortex. tDCS is a technique by which low electric current applied to the scalp modulates the resting potentials of underlying neural populations and can be used to test structure-function relationships. Eleven normal young adults received cathodal, anodal, or sham stimulation over right inferior posterior parietal cortex and then performed separate blocks of an object WM task probed by recall or recognition. The results showed that cathodal stimulation selectively impaired WM on recognition trials. These data replicate and extend our previous findings of preserved WM recall and impaired WM recognition in patients with parietal lobe lesions.
working memory; tDCS; parietal; internal attention; recognition; recall
Non-invasive measurement of resting state cerebral blood flow (CBF) may reflect alterations of brain structure and function after traumatic brain injury (TBI). However, previous imaging studies of resting state brain in chronic TBI have been limited by several factors, including measurement in relative rather than absolute units, use of crude spatial registration methods, exclusion of subjects with substantial focal lesions, and exposure to ionizing radiation, which limits repeated assessments. This study aimed to overcome those obstacles by measuring absolute CBF with an arterial spin labeling perfusion fMRI technique, and using an image preprocessing protocol that is optimized for brains with mixed diffuse and focal injuries characteristic of moderate and severe TBI. Resting state CBF was quantified in 27 individuals with moderate to severe TBI in the chronic stage, and 22 demographically matched healthy controls. In addition to global CBF reductions in the TBI subjects, more prominent regional hypoperfusion was found in the posterior cingulate cortices, the thalami, and multiple locations in the frontal cortices. Diffuse injury, as assessed by tensor-based morphometry, was mainly associated with reduced CBF in the posterior cingulate cortices and the thalami, where the greatest volume losses were detected. Hypoperfusion in superior and middle frontal cortices, in contrast, was associated with focal lesions. These results suggest that structural lesions, both focal and diffuse, are the main contributors to the absolute CBF alterations seen in chronic TBI, and that CBF may serve as a tool to assess functioning neuronal volume. We also speculate that resting reductions in posterior cingulate perfusion may reflect alterations in the default-mode network, and may contribute to the attentional deficits common in TBI.
arterial spin labeling; cerebral blood flow; lesion; magnetic resonance imaging; traumatic brain injury
Models of speech perception are in general agreement with respect to the major cortical regions involved, but lack precision with regard to localization and lateralization of processing units. To refine these models we conducted two Activation Likelihood Estimation (ALE) meta-analyses of the neuroimaging literature on sublexical speech perception. Based on foci reported in 23 fMRI experiments, we identified significant activation likelihoods in left and right superior temporal cortex and the left posterior middle frontal gyrus. Subanalyses examining phonetic and phonological processes revealed only left mid-posterior superior temporal sulcus activation likelihood. A lateralization analysis demonstrated temporal lobe left lateralization in terms of magnitude, extent, and consistency of activity. Experiments requiring explicit attention to phonology drove this lateralization. An ALE analysis of eight fMRI studies on categorical phoneme perception revealed significant activation likelihood in the left supramarginal gyrus and angular gyrus. These results are consistent with a speech processing network in which the bilateral superior temporal cortices perform acoustic analysis of speech and nonspeech auditory stimuli, the left mid-posterior superior temporal sulcus performs phonetic and phonological analysis, and the left inferior parietal lobule is involved in detection of differences between phoneme categories. These results modify current speech perception models in three ways: 1) specifying the most likely locations of dorsal stream processing units, 2) clarifying that phonetic and phonological superior temporal sulcus processing is left lateralized and localized to the mid-posterior portion, and 3) suggesting that both the supramarginal gyrus and angular gyrus may be involved in phoneme discrimination.
auditory; categorical perception; phoneme; phonetic; phonology; speech perception; fmri; meta-analysis; neuroimaging; language
Although evidence suggests that patients with left hemisphere strokes and nonfluent aphasia who receive 1 Hz repetitive transcranial magnetic stimulation (rTMS) over the intact right inferior frontal gyrus experience persistent benefits in naming, it remains unclear whether the effects of rTMS in these patients generalize to other language abilities. We report a subject with chronic nonfluent aphasia who showed stable deficits of elicited propositional speech over the course of five years, and received 1200 pulses of 1 Hz rTMS daily for 10 days at a site identified as being optimally responsive to rTMS in this patient. Consistent with prior studies there was improvement in object naming, with a statistically significant improvement in action naming. Improvement was also demonstrated in picture description at 2, 6, and 10 months after rTMS with respect to the number of narrative words and nouns, sentence length, and use of closed class words. Compared to his baseline performance, the patient showed significant improvement on the Western Aphasia Battery subscale for spontaneous speech. These findings suggest that manipulation of the intact contralesional cortex in patients with nonfluent aphasia may result in language benefits that generalize beyond naming to include other aspects of language production.
Interhemispheric interactions; language; TMS; inferior frontal gyrus; discourse; propositional speech
The cerebellum has long been implicated in time perception, particularly in the subsecond range. The current set of studies examines the role of the cerebellum in suprasecond timing, using analysis of behavioral data in subjects with cerebellar lesions. Eleven cerebellar lesion subjects and 17 controls were tested on temporal estimation, reproduction and production, for times ranging from 2 to 12 s. Cerebellar patients overproduced times on both the reproduction and production tasks; the effect was greatest at the shortest duration. A subset of patients also underestimated intervals. Cerebellar patients were significantly more variable on the estimation and reproduction tasks. No significant differences between normal and cerebellar patients were found on temporal discrimination tasks with either sub- or suprasecond times. Patients with damage to the lateral superior hemispheres or the dentate nuclei showed more significant impairments than those with damage elsewhere in the cerebellum, and patients with damage to the left cerebellum had more significant differences from controls than those with damage to the right. These data suggest that damage to the middle-to-superior lobules or the left hemisphere is especially detrimental to timing suprasecond intervals. We suggest that this region be considered part of a network of brain structures including the DLPFC that is crucial for interval timing.
cerebellum; time perception; lesion-based
Patients with “refractory semantic access deficits” demonstrate several unique features that make them important sources of insight into the organization of semantic representations. Here we attempt to replicate several novel findings from single-case studies reported in the literature. Patient UM– 103 displays the cardinal features of a “refractory semantic access deficit” and showed many of the same effects of semantic relatedness reported in the literature. However, when probing concrete and abstract words, this patient revealed very different patterns of performance compared to two previously reported patients. We discuss the implications of our data for models of semantic organization of abstract and concrete words.
Voxel-based lesion symptom mapping (VLSM) techniques have been important in elucidating structure-function relationships in the human brain. Rorden, Karnath & Bonilha (2007b) introduced the nonparametric Brunner-Munzel rank order test as an alternative to parametric tests often used in VLSM analyses. However, the Brunner-Munzel statistic produces inflated z scores when used at any voxel where there are less than ten subjects in either the lesion or no lesion groups. Unfortunately, a number of recently published VLSM studies using this statistic include relatively small patient populations, such that most (if not all) examined voxels do not meet the necessary criteria. We demonstrate the effects of inappropriate usage of the Brunner-Munzel test using a dataset included with MRIcron, and find large Type I errors. To correct for this we suggest that researchers use a permutation-derived correction as implemented in current versions of MRIcron when using the Brunner-Munzel test.
voxel-based lesion symptom mapping; VLSM; brain-lesion mapping; lesion; voxel; structure-function