Taalverwerking na een beroerte: wat individuele fMRI-lokalisatie ons hierover kan leren
- KatjaDe Meyer
In België maken dagelijks wel 50 mensen een beroerte door. Ongeveer één op drie ontwikkelt hierdoor een stoornis in het begrijpen of produceren van taal, ook wel afasie genoemd. Dikwijls herstelt de taal bij deze mensen weer doorheen de tijd, maar er bestaat veel discussie over hoe dat herstelproces precies verloopt in de hersenen. Voor ons, als logopediestudenten, leek dit bijzonder interessant om in onze masterproef verder te onderzoeken. Ons onderzoek suggereert dat vooral activatie van de oorspronkelijke taalregio’s van belang is voor een goede taalfunctie bij personen met afasie en dat er geen evidentie is voor compensatie door andere hersennetwerken. Onze individu-gerichte fMRI-methode maakt ons onderzoek een waardevolle aanvulling op de bestaande literatuur.
Taalverwerking in de hersenen
De verwerking van taal in de hersenen is heel complex. Zelfs voor eenvoudige handelingen, zoals gedag zeggen aan je buurman of naar het nieuws luisteren, zijn verschillende hersengebieden actief. Die hersenregio’s staan met elkaar in verbinding en werken samen voor het begrijpen en produceren van taal. Dit geheel noemen we het taalnetwerk. Dit netwerk ligt verspreid doorheen de hersenen, maar ligt bij de meeste mensen voornamelijk in de linkerhersenhelft.
Maar soms loopt het mis…
Stel je eens voor dat je wakker wordt en plotseling moeite hebt met spreken of begrijpen wat anderen zeggen. Dit is de realiteit voor veel mensen die door een beroerte afasie ontwikkelen. Afasie is een stoornis in het begrijpen of produceren van taal die ontstaat wanneer de beroerte hersenschade veroorzaakt in het taalnetwerk. De impact hiervan op het dagelijkse leven van deze mensen is enorm.
Herstel is mogelijk
Gelukkig is er goed nieuws! Onze hersenen blijven namelijk niet bij de pakken zitten en gaan op zoek naar een oplossing. Dat blijkt uit het feit dat veel mensen na een beroerte herstellen en geleidelijk weer beter gaan functioneren. Ook bij personen met afasie verbetert het taalbegrip en uitdrukkingsvermogen vaak weer doorheen de tijd. Maar hoe komt dat dan?
Compensatie als reddende engel?
Onderzoekers zijn nog niet zeker welk proces in de hersenen hieraan ten grondslag ligt. Sommige studies suggereren dat de vooruitgang vooral te danken is aan herstel van het taalnetwerk zelf. Andere onderzoekers beweren dat andere, niet-taalgerelateerde hersengebieden een handje helpen. Dat proces wordt compensatie genoemd, aangezien de activatie van deze andere hersengebieden zou compenseren voor het wegvallen van taalverwerking in de beschadigde taalgebieden.
Voor taal wordt compensatie dikwijls gezocht in twee netwerken: enerzijds in de rechterhersenhelft, meer bepaald in de gebieden die qua locatie overeenkomen met het taalnetwerk in de linkerhersenhelft, en anderzijds in het ‘multiple-demandnetwerk’. Dit multiple-demandnetwerk ondersteunt cognitieve processen, zoals het werkgeheugen en cognitieve controle, en wordt vooral actief bij moeilijke taken, ongeacht de taakinhoud. Volgens sommige wetenschappers vertoont het multiple-demandnetwerk dus extra activiteit wanneer de taalverwerking door een beroerte moeizamer verloopt, om de taalverwerking zoveel mogelijk te ondersteunen.
Tegenstrijdigheden in de literatuur
Het herstelmechanisme in kaart brengen is cruciaal voor de klinische praktijk. Als compensatie door het multiple-demandnetwerk daadwerkelijk een rol zou spelen, zou taaltherapie aangevuld kunnen worden met cognitieve oefeningen. Een eenduidig antwoord is echter nog ver te zoeken in de literatuur. De uiteenlopende onderzoeksresultaten zijn deels te wijten aan het gebruik van onnauwkeurige onderzoeksmethoden. Maar hoe verloopt dat onderzoek dan? En hoe kan het beter?
Zoeken naar antwoorden met fMRI
Functionele MRI-scans zijn een belangrijke tool in het onderzoeken van hersenactiviteit. Wanneer een proefpersoon tijdens de scan een taaltaak uitvoert, kan de fMRI-afbeelding heel precies tonen waar de hersenactivatie, en daarmee het taalnetwerk, zich bevindt. Om de gevonden hersenactivatie juist te interpreteren, vergelijken we de resultaten van de personen met afasie met een gezonde controlegroep.
Traditionele benadering van fMRI-onderzoek
Lange tijd werd er bij deze fMRI-onderzoeken gebruikgemaakt van groepsgemiddelden. In die traditionele benadering werden de hersenafbeeldingen van verschillende proefpersonen op elkaar geprojecteerd. Enkel de gebieden die bij de meeste proefpersonen tegelijk activiteit vertoonden, werden verder geanalyseerd; de rest niet.
In realiteit is het echter wat complexer. De functionele opbouw van de hersenen verschilt namelijk van persoon tot persoon. In jouw hersenen zullen net iets andere anatomische regio’s actief zijn tijdens taalverwerking dan bij iemand anders, en dat is volkomen normaal. Als de hersenscans van de proefpersonen zomaar op elkaar geprojecteerd worden, wordt geen rekening gehouden met deze normale variatie, waardoor relevante informatie verloren gaat.
Individuele netwerklokalisatie biedt duidelijkheid
In plaats van alleen de overlappende activiteit tussen proefpersonen te analyseren (paars op de afbeelding), lokaliseerden en analyseerden wij de taalregio’s per individu (roos en blauw op de afbeelding) a.d.h.v. een individuele lokalisatiebenadering. Hiervoor gebruikten we twee lokalisatietaken: een luister- en een leestaak. De luistertaak werd in ons onderzoek voor het eerst toegepast bij personen met afasie. Aangezien het taalnetwerk met deze vernieuwende aanpak zeer nauwkeurig gelokaliseerd kan worden, behouden we meer relevante informatie, wat onze resultaten veel betrouwbaarder maakt.
Taalnetwerk staat centraal
De belangrijkste bevinding van ons onderzoek is dat de linkszijdige gebieden van het oorspronkelijke taalnetwerk de belangrijkste factor lijken te zijn voor de taalfunctie bij afasie. Deze gebieden zijn namelijk minder actief bij personen met afasie dan bij gezonde ouderen. Bovendien zagen we interessante, maar niet-significante, verbanden tussen activiteit in de taalregio’s en performantie op taaltaken: meer activatie in deze gebieden lijkt samen te hangen met betere taalverwerking.
Daarnaast vonden we geen bewijs voor compensatiemechanismen, noch in de taalgebieden in de rechterhersenhelft, noch in het cognitieve multiple-demandnetwerk. Dit multiple-demandnetwerk bleek zelfs bij geen van beide groepen betrokken bij de taalverwerking.
Van onderzoek naar de klinische praktijk
Onze resultaten moeten met voorzichtigheid geïnterpreteerd worden, vanwege de exploratieve aard van het onderzoek en de kleine steekproef. Toch draagt het onderzoek wel degelijk interessante conclusies aan, dankzij onze nauwkeurige individugerichte fMRI-methode. Nog belangrijker dan de resultaten van het onderzoek zelf, zijn de implicaties voor de klinische praktijk. Aangezien het multiple-demandnetwerk niet betrokken lijkt bij taalverwerking of compensatie bij afasie, lijkt cognitieve therapie minder effectief. In plaats daarvan lijken de bevindingen erop te wijzen dat vooral het versterken van de taalregio’s, via taalgerichte therapie, het herstel van de taalvaardigheden bevordert. Taalherstel vraagt dus taaltherapie.
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