"Hand/mouth goal-directed action representations" is another way of saying "gestural communication", "gestural language", or "communication through body language". The recent finding that Broca's area is active when people are observing others engaged in meaningful action is evidence in support of this idea. It was hypothesized that a precursor to the modern Broca's area was involved in translating gestures into abstract ideas by interpreting the movements of others as meaningful action with an intelligent purpose. It is argued that over time the ability to predict the intended outcome and purpose of a set of movements eventually gave this area the capability to deal with truly abstract ideas, and therefore (eventually) became capable of associating sounds (words) with abstract meanings. The observation that frontal language areas are activated when people observe Hand Shadows is further evidence that human language may have evolved from existing neural substrates that evolved for the purpose of gesture recognition. The study, therefore, claims that Broca's area is the "motor center for speech", which assembles and decodes speech sounds in the same way it interprets body language and gestures. Consistent with this idea is that the neural substrate that regulated motor control in the common ancestor of apes and humans was most likely modified to enhance cognitive and linguistic ability. Studies of speakers of American Sign Language and English suggest that the human brain recruited systems that had evolved to perform more basic functions much earlier; these various brain circuits, according to the authors, were tapped to work together in creating language.
Broca saw an opportunity in Leborgne. At the time there was a debate occurring in some circles of the scientific community; it was centered around the question of whether certain areas of the brain were specialized for certain functions, or if the entire brain was utilized in the performance of every function. The former view, sometimes referred to as localization of function, was the perspective Broca was leaning toward.
One function that advocates of localization (sometimes called localizationists) had argued strongly in favor of being localized was speech. Previous evidence had suggested that the faculty for speech might be centered in the frontal lobes. Thus, when Broca encountered Leborgne he saw an opportunity to test this hypothesis. After Leborgne died, Broca quickly performed an autopsy. Upon examining the brain, Broca found a crater in the left frontal lobe that he described as being as large as a "chicken's egg."
Functional MRI has enabled us to map the anatomical location of functional areas of brain including language centers and thus provides useful insights in preoperative planning and assessment for neurosurgeons. In recent years, fMRI has also provided evidence for neuroplasticity which implies that brain pathways have an ability to reorganize in response to any injury.
The primary centers implicated in language processing consist of motor speech area (Broca area), located in posterior inferior frontal gyrus and receptive language center (Wernicke area), located along posterior superior temporal gyrus. Additional involvement of temporal, parietal and frontal lobes in language processing has been noted in recent studies .
In a randomized controlled clinical trial with blinded assessment, 290 eligible patients with aphasia due to stroke will be randomly allocated into a control group or an experimental group. The course of this trial will comprise a 4-week intervention and a 12-week follow-up period. Five assessment points, including baseline, 2 and 4 weeks after treatment, 6 and 12 weeks after follow-up, are set to dynamically observe the changes of curative effects. Primary outcome measures are the differences in the score on both the China rehabilitation research center aphasia examination (CRRCAE) and Boston diagnostic aphasia examination - Chinese version (BDAE-C) after intervention and follow-up. The Modified Barthel Index (MBI), 36-Item Short Form Health Survey (SF-36), and results of blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examination are considered as the secondary outcome measures. Other outcomes will include rate of adverse events and economic effects.
If the outcome is positive, this project will offer a low-cost appropriate technology for community health centers (CHCs) in the rehabilitation of aphasia patients after stroke, and could be implemented on a large scale, both in China and worldwide.
The current study uses a multicentre, cluster randomized, parallel-controlled superiority design with blinded assessment (a flow diagram of the study design is presented in Figure 1). The course of this trial will comprise a 4-week intervention and a 12-week follow-up period. The control group will receive SLT and initial therapies, while, the experimental group will receive additional scalp acupuncture. There is a total of five time points, including baseline, 2 weeks after treatment, 4 weeks after treatment, 6 weeks after follow-up, and 12 weeks after follow-up. Fujian University of Traditional Chinese Medicine (FJTCM), as an undertaker of this project, is responsible for completing the training of the rehabilitation therapists in a unified standard way before the study, and supervising their operations regularly during the study at all clinical sites. The Center of Evidence-based Medicine in FJTCM, which plays a role in randomization and will be blinded to the intervention, is an independent department employed to monitor and analyze data. The present project, funded by the State Administration of Traditional Chinese Medicine, has received approval from the local ethics committees of every center (Fujian: 2013KY-006-01, approval received in July 2013; Henan: 2014HL010, approval received in March 2014; Shandong: 2013KY-006-01, approval received in March 2014) participated in the study. Written informed consent is required prior to participation from each participant or their guardian, and they will be informed of the nature of this trial including its purpose, procedures involved, expected duration, potential risks and discomfort, as well as the possible benefits they will receive from it. There is no time limit for them to ask related questions and respond to the invitation to participate. Participants will be also informed that they are free to withdraw from the study at any stage for any reason and their personal information will be undisclosed and kept securely at FJTCM.
The protocol will be carried out at community health centers (CHCs) run by three sub-centers, including the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (Fujian province, China), the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine (Shandong province, China), and the First Affiliated Hospital of Henan College of Traditional Chinese Medicine (Henan province, China). Many CHCs in different areas of the three provinces will be included in this protocol, providing a large number of patients.
Each participating CHC will be assigned to either experimental group or control group by restricted randomization generated by an independent statistician, who works in the evidence-based center of FJTCM, via SAS software (Version 8.2, SAS Institute, Cary, North Carolina, United States). The random allocation sequence is blinded to the screeners who make the baseline test for the patients, and protected by a specified project manager who is not involved in the recruitment program of this study. Both allocation and baseline measurements will be concealed to outcome assessors.
A limitation of this study is that this protocol is not double-blind and has no placebo control. However, the intervention group will be blinded to the evidence-based medicine center to decrease possible bias. The study also cannot eliminate the confounding effects from the spontaneous recovery in the early stage of stroke.
STOOKEY B (1963). Jean-Baptiste Bouillaud and Ernest AUBURTIN. Early studies on cerebral localization and the speech center. JAMA : the journal of the American Medical Association, 184, 1024-9 PMID: 13984405
Be suspicious of any statement that says a brain area is a center responsible for some function. The notion of functions being products of brain areas or centers is left over from the days when most evidence about brain function was based on the effects of brain lesions localized to specific areas. Today, we think of functions as products of systems rather than of areas. Neurons in areas contribute because they are part of a system. The amygdala, for example, contributes to threat detection because it is part of a threat detection system. And just because the amygdala contributes to threat detection does not mean that threat detection is the only function to which it contributes. Amygdala neurons, for example, are also components of systems that process the significance of stimuli related to eating, drinking, sex, and addictive drugs. 041b061a72