Resting-state functional connectivity: An emerging method for the study of language networks in post-stroke aphasia

Aphasia results both from direct effects of focal damage to eloquent cortical areas as well as dysfunction of interconnected remote areas within the language network. Resting-state functional MRI (rsfMRI) can be used to examine functional connectivity (FC) within these networks. Herein we review publications, which applied rsfMRI to understand network pathology in post stroke aphasia. A common finding in this research is an acute disruption of connectivity within the language network, which is correlated with loss of language function and tends to resolve with recovery from aphasia. All studies are limited by small sample sizes, heterogeneous patient characteristics and a wide range of analytical approaches, which further hinder deduction of common patterns across studies. One recent large-scale study examining FC and behavior across various cognitive domains, however, has made substantial progress with the description of a "network phenotype of stroke injury", which consists of a disruption of interhemispheric connectivity and reduced segregation of intrahemispheric networks. Unlike in other domains, language functions showed substantial dependence on intact left intrahemispheric connectivity (Siegel, Ramsey et al., 2016). In the future, such analyses of network pathology might support prognosis and development of effective treatment strategies in individual patients with aphasia.