Over time there is, for a number of patients at least, diminished recruitment of right hemisphere structures for language tasks. Eventually, for some patients with chronic aphasia, significant language recovery is associated with Lumacaftor mw redistribution of language processing back to left hemisphere perisylvian areas. Intervention with noninvasive brain stimulation may work in several different ways. To date, most therapeutic stimulation studies have employed inhibitory stimulation of right hemisphere structures. This approach may modulate

both right and left hemisphere components of chronically reorganized language networks in ways that allow them to function more efficiently. The effect of stimulation in the right hemisphere may be to down-regulate local inhibition of right hemisphere regions engaged in language-related tasks. Concurrently, inhibitory stimulation of intact contralesional cortical areas may facilitate increased recruitment of perilesional regions of the left hemisphere into reorganized language networks by diminishing the impact of transcallosal inhibitory inputs to those areas. Finally, although it has been proposed that the effects of noninvasive brain stimulation are specific with respect to their

effect on reorganized language networks, it may be the case that the changes in language performance observed after brain stimulation may relate to alterations in cerebral function that are less focal and that may affect a variety AZD2281 supplier of neural functions

in ways that have not yet been described. Further investigations will be critical to further clarifying the impact of noninvasive brain stimulation on different mechanisms of aphasia recovery. Noninvasive brain stimulation provides a potentially promising set of tools for understanding and enhancing aphasia recovery. Future investigations BCKDHB involving noninvasive brain stimulation may be able to further characterize the roles of the left and right hemispheres in aphasia recovery by employing a variety of experimental manipulations. For example, noninvasive brain stimulation techniques could be paired with behavioral techniques that are believed to facilitate right hemisphere involvement in language tasks (Crosson et al., 2007 and Schlaug et al., 2009). Other investigations may explore the degree to which reorganized language networks in the right hemisphere share functional homology with perisylvian language circuits in the left hemisphere. Administration of therapeutic rTMS to different regions in the right hemisphere could result in manipulation of specific linguistic processes, further elucidating structure–function relationships in reorganized language networks. Additional noninvasive stimulation studies could further characterize temporal aspects of language recovery by stimulating the right and left hemispheres at different timepoints relative to stroke onset.