Right Hemisphere and Speech Recovery in Post-Stroke Aphasia



The analytical review presents the clinical, neurobiological, and neuropsychological aspects of post-stroke aphasia as well as the role of the right hemisphere in speech recovery. The paper shows the influence of size, topography, lesion depth, cerebral hemodynamic plasticity, initial morphometric characteristics of the brain, and handedness on the functional recovery of aphasia. The review considers the typology and mechanisms of the appearance of "stealing symptoms" of homologous and non-homologous regions of the intact hemisphere. The "low-level" and "high-level" models of language competence of the right hemisphere are analyzed. The study describes the topography of the brain activation regions in the intact hemisphere during various speech task-solving. The paper shows the heterochrony between impressive and expressive speech recovery in aphasics and its bilateral inter-lateral distribution. The authors conclude that to clarify the mechanisms of aphasia recovery, it is necessary for a comprehensive account of clinical, neurobiological and neuropsychological patterns of speech disorder reparation in different post-stoke epochs. The paper notices that a deeper understanding of the impact of structural and functional repairment of speech processes on the aphasia outcome, it needs to assess the relationship between the degree of speech disorders reduction and the lateral vector of speech architectonics in the post-stroke period.

General Information

Keywords: post-stroke aphasia, right hemisphere, speech reorganization, speech recovery, spontaneous compensation, diaschisis

Journal rubric: Theoretical Research

Article type: scientific article

DOI: https://doi.org/10.17759/cpse.2023120105

Received: 30.01.2023


For citation: Shipkova K.M., Bulygina V.G. Right Hemisphere and Speech Recovery in Post-Stroke Aphasia [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2023. Vol. 12, no. 1, pp. 104–125. DOI: 10.17759/cpse.2023120105. (In Russ., аbstr. in Engl.)


  1. Balashova I.N., Egorov A.Yu. Izmenenie profilei funktsional'noi asimmetrii u bol'nykh s rechevymi narusheniyami posle pravo- i levopolusharnogo insul'ta [Changes in functional asymmetry profiles in patients with speech disorders after right- and left-hemispheric stroke]. In V.A. Moskvin (ed.), Neiropsikhologiya i psikhofiziologiya individual'nykh razlichii = Neuropsychology and psychophysiology of individual differences. Issue 2. Moscow, Belgorod: Politerra, 2007, pp. 87–102. (In Russ.).
  2. Bragina L.K. Rentgenologicheskaya diagnostika ateroskleroza v sisteme sonnykh arterii: а dis. … kand. med. nauk. [X-ray diagnostics of atherosclerosis in the carotid artery system. PhD (Psychology) Dissertation Thesis]. Moscow, 1966. 23p. (In Russ.).
  3. Buklina S.B., Batalov A.I. Vosstanovlenie rechi pri afazii: Pravoe polusharie vrag ili drug? [Improvement of speech function in patients with aphasia: The right hemisphere, an enemy or a friend?]. Fiziologiya cheloveka = Human Physiology, 2018, vol. 44, no. 2, pp. 52–59. DOI: 10.7868/S013116461802008X (In Russ., abstr. in Engl.).
  4. Vizel T.G. Ambidekstriya – mif ili real'nost'? [Ambidexterity — myth or reality?]. Asimmetriya = Journal of Asymmetry, 2023, vol. 17, no. 1, pp. 22–38. DOI: 10.25692/ASY.2023.1.17.0023 (In Russ., abstr. in Engl.).
  5. Kuznetsova S.M. Polusharnye osobennosti postinsul'tnoi reorganizatsii metabolizma i tserebral'noi gemodinamiki [Hemispheric features of post-stroke reorganization of metabolism and cerebral hemodynamics]. In S. N. Illarioshkin, V.F. Fokin (eds.), Materialy vserossiiskoi konferentsii s mezhdunarodnym uchastiem «Sovremennye napravleniya issledovanii funktsional'noi mezhpolusharnoi asimmetrii i plastichnosti mozgA» = Materials of the Russian conference with international participation "Modern research directions of functional hemispheric asymmetry and brain plasticity", Moscow, December 2-3, 2010. Moscow: Nauchnyi Mir, 2010. Pp. 182–187. (In Russ.).
  6. Mayorova L.A. Reorganizatsiya protsessov nachal'nogo ehtapa vospriyatiya rechi u patsientov s postinsul'tnoi sensornoi afaziei: FMRT – issledovanie: avtoref. dis. … kand. med. nauk. [Reorganization of the processes of the initial stage of speech perception in patients with post–stroke sensory aphasia: fMRI study: PhD (Psychology) Dissertation Thesis]. Moscow, 2013. 24 p. (In Russ.).
  7. Malyukova N.G. Neiropsikhologicheskie sindromy pri insul'takh v basseine levoi srednei mozgovoi arterii: avtoref. dis. … kand. psikhol. nauk [Neuropsychological syndromes in strokes in the basin of the left middle cerebral artery: PhD (Psychology) Dissertation Thesis]. Moscow, 2002. 24 p. (In Russ.).
  8. Stolyarova L.G. O nekotorykh osobennostyakh afazicheskikh rasstroistv pri trombozakh i stenozakh vnutrennei sonnoi i srednei mozgovoi arterii [On certain peculiarities of aphasic disturbances in thromboses and stenosis of the internal carotid and middle cerebral arteries]. Zhurnal nevropatologii i psikhiatrii im. S.S. Korsakova = The Korsakov’s Journal of Neurology and Psychiatry, 1964, vol. 64, no. 2, pp. 225–231. (In Russ.).
  9. Tonkonogii I.M., Puante A. Klinicheskaya neiropsikhologiya [Clinical neuropsychology]. Saint-Petersburg: Piter, 2007. 526 p. (In Russ.).
  10. Tsvetkova L.S. Afaziologiya: sovremennye problemy i puti ikh resheniya [Aphasiology: Modern problems and ways to solve them]. 2nd ed. Moscow: publ. of MPSU, 2010. 744 p. (In Russ.).
  11. Shipkova K.M. Ispol'zovanie muzykoobogashchennoi sredy pri narusheniyakh kognitivnykh funktsii u vzroslykh (teoreticheskii obzor) [The use of music-enriched environment in cognitive impairment in adults (theoretical review)]. Klinicheskaya i spetsial'naya psikhologiya = Clinical Psychology and Special Education, 2020, vol. 9, no. 1, pp. 64–77. DOI: 10.17759/cpse.2020090104 (In Russ., abstr. in Engl.).
  12. Shipkova K.M. Lateralizatsiya slukhorechevoi asimmetrii pri afazicheskikh rasstroistvakh i ee vliyanie na ehffektivnost' dikhoticheskogo proslushivaniya serii odnoslozhnykh slov i dinamiku vosstanovleniya rechi [Lateralization of auditory speech asymmetry in aphasic disorders and the influence of its vector on the efficiency of dichotic listening to a series of C-V-C words and the dynamics of speech recovery]. Sibirskii psikhologicheskii zhurnal = Siberian Journal of Psychology, 85, pp. 161–172. DOI: 10.17223/17267080/85/8 (In Russ., abstr. in Engl.).
  13. Shipkova K.M. Sovremennye zarubezhnye neirokognitivnye podkhody k ispol'zovaniyu muzykoobogashchennoi sredy v reabilitatsii afazicheskikh rasstroistv i dementsii al'tsgeimerovskogo tipa [Modern foreign neurocognitive approaches to the use of the music-enriched environment in the rehabilitation of aphasic disorders and Alzheimer's type dementia]. Sovremennaya zarubezhnaya psikhologiya = Journal of Modern Foreign psychology, 2021, vol. 10, no. 1. pp. 126–137. DOI: 10.17759/jmfp.2021100412. (In Russ., abstr. in Engl.).
  14. Shipkova K.M., Grishina E.G., Shklovskii V.M. Rol' mezhpolusharnogo vzaimodeistviya v dinamike neiropsikhologicheskogo sindroma [The role of hemispheric interaction in the dynamics of neuropsychological syndrome]. In T.V Akhutina, Zh.M. Glozman (eds.), R. Luriya i psikhologiya XXI veka = A.R. Luriya and Modern Psychology. Moscow, 2003. Pp. 152–155. (In Russ.).
  15. Anglade C., Thiel A., Ansaldo A.I. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: А critical review of literature. Brain Injury, 2014, vol. 28, no. 2, pp. 138–145. DOI: 10.3109/02699052.2013.859734
  16. Ansaldo A.I. La contribution de l’hémisphère droit à la récupération de l’aphasie: exemples de plasticité adaptée et dysfonctionnelle et pistes d’intervention. [The contribution of the right hemisphere to the recovery of aphasia: examples of adapted and dysfunctional plasticity and avenues for intervention]. In Y. Joanette, L. Monetta (eds.), Hemisphere droit et communication verbal = Right Hemisphere and Verbal Communication. Paris, 2004. Pp. 79–95. DOI: 10.3109/02699052.2013.859734
  17. Brady M.C., Ali M., VandenBerg K. et al. Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis. International Journal of Stroke, 2022, vol. 17, pp. 1067–1077. DOI: 10.1177/17474930221097477
  18. Chang A.J., Wilmskoetter J., Fridriksson J. et al. Cortical microstructural changes associated with treated aphasia recovery. Annals of Clinical and Translational Neurology, 2021, vol. 8, pp. 1884–1894. DOI: 10.1002/acn3.51445
  19. Cocquyt E.M., De Ley L., Santens P. et al. The role of the right hemisphere in the recovery of stroke-related aphasia: A systematic review. Journal of Neurolinguistics, 2017, vol. 44, pp. 68–90. DOI: 1016/j.jneuroling.2017.03.004
  20. Crosson B., Warren L. Dichotic ear preference for С-V-C words in Wernike’s and Broca’s aphasias. Cortex, 1981, vol. 17, no. 2, pp. 249–258. DOI: 10.1016/s0010-9452(81)80045-7
  21. Demeurisse G., Capon A. Brain activation during a linguistic task in conduction aphasia. Cortex, 1991, vol. 27, no. 2, pp. 285–294. DOI: 10.1016/S0010-9452(13)80133-5
  22. Egorova-Brumley N., Khlif M.S., Werden E. et al. Grey and white matter atrophy 1 year after stroke aphasia. Brain Communications, 2022, vol. 4, no. 2, article fcac061. DOI: 10.1093/braincomms/fcac061
  23. Fan L., Li C., Huang Z.G. et al. The longitudinal neural dynamics changes of whole brain connectome during natural recovery from poststroke aphasia. Neuroimage. Clinical, 2022, vol. 36, article 103190. DOI: 10.1016/j.nicl.2022.103190
  24. Fridriksson J., Hillis A.E. Current approaches to the treatment of post-stroke aphasia. Journal of Stroke, 2021, vol. 23, no. 2, pp. 183–201. DOI: 10.5853/jos.2020.05015
  25. Friston K.J., Price C.J. Modules and brain mapping. Cognitive Neuropshychology, 2011, vol. 28, no. 3–4, pp. 241–250. DOI: 10.1080/02643294.2011.558835
  26. Gainotti G. Lower- and higher-level models of right hemisphere language. A selective survey. Functional Neurology, 2016, vol. 31, no. 2, pp. 67–73. DOI: 10.11138/fneur/2016.31.2.067
  27. Gainotti G. The riddle of the right hemisphere's contribution to the recovery of language. European Journal of Disorders of Communication, 1993, vol. 28, no. 3, pp. 227–246. DOI: 10.3109/13682829309060038
  28. García-Casares N., Barros-Cano A., García-Arnés J.A. Melodic intonation therapy in post-stroke non-fluent aphasia and its effects on brain plasticity. Journal of Clinical Medicine, 2022, vol. 11, no. 2. Article 3503. DOI: 10.3390/jcm11123503
  29. Gerstenecker A., Lazar R.M. Language recovery following stroke. Clinical Neuropsychology, 2019, vol. 33, no. 5, pp. 928–947. DOI: 10.1080/13854046.2018.1562093
  30. Hartwigsen G., Saur D. Neuroimaging of stroke recovery from aphasia – Insights into plasticity of the human language network. Neuroimage, 2019, vol. 190, pp. 14–31. DOI: 10.1016/j.neuroimage.2017.11.056
  31. Heiss W.D., Thiel A. A proposed regional hierarchy in recovery of post-stroke aphasia. Brain and Language, 2006, vol. 98, no. 1, pp. 118–123. DOI: 10.1016/j.bandl.2006.02.002
  32. Kiran S., Meier E.L., Johnson J.P. Neuroplasticity in aphasia: A proposed framework of language recovery. Journal of Speech, Language, and Hearing Research, 2019, vol. 62, no. 11, pp. 3973–3985. DOI: 10.1044/2019_JSLHR-L-RSNP-19-0054
  33. Kiran S., Thompson C.K. Neuroplasticity of language networks in aphasia: advances, updates, and future challenges. Frontiers in Neurology, 2019, vol. 10, article 295. DOI: 10.3389/fneur.2019.00295
  34. Kolb B., Teskey C.G., Gibb R. Factors influencing cerebral plasticity in the normal and injured brain. Frontiers in Human Neuroscience, 2010, vol. 4, article 204. DOI: 10.3389/fnhum.2010.00204
  35. Kristinsson S., Busby N., Rorden C. et al. Brain age predicts long-term recovery in post-stroke aphasia. Brain Communications, 2022, vol. 4, no. 5, article fcac252. DOI: 10.1093/braincomms/fcac252
  36. Lahiri D., Ardila A., Dubey S. et al. A longitudinal study of aphasia due to pure sub-cortical strokes. Annals of Indian Academy of Neurology, 2020, vol. 23, suppl. 2, pp. S109–S115. DOI: 10.4103/aian.AIAN_475_20
  37. Lidzba K., de Haan B., Wilke M. et al. Lesion characteristics driving right-hemispheric language reorganization in congenital left-hemispheric brain damage. Brain and Language, 2017, vol. 173, pp. 1–9. DOI: 10.1016/j.bandl.2017.04.006
  38. Lwi S.J., Herron T.J., Curran B.C. et al. Auditory comprehension deficits in post-stroke aphasia: Neurologic and demographic correlates of outcome and recovery. Frontiers in Neurology, 2021, vol. 12. DOI: 10.3389/fneur.2021.680248
  39. Moore W.H., Weidner W.E. Dichotic word-perception of aphasic and normal subjects. Perceptual and Motor Skills, 1975, vol. 40, no. 2, pp. 379–386. DOI: 10.2466/pms.1975.40.2.379
  40. Nair V.A., Young B.M., La C. et al. Functional connectivity changes in the language network during stroke recovery. Annals of Clinical and Translational Neurology, 2015, vol. 2, no. 2, pp. 185–195. DOI: 10.1002/acn3.165
  41. Nasios G., Dardiotis E., Messinis L. From Broca and Wernicke to the neuromodulation era: Insights of brain language networks for neurorehabilitation. Behavioural Neurology, 2019, article 9894571. DOI: 10.1155/2019/9894571
  42. Osa García A., Brambati S.M., Brisebois A. et al. Predicting early post-stroke aphasia outcome from initial aphasia severity. Frontiers in Neurology, 2020, vol. 11, article 120. DOI: 10.3389/fneur.2020.00120
  43. Pasquini L., Di Napoli A., Rossi-Espagnet M.C. et al. Understanding language reorganization with neuroimaging: How language adapts to different focal lesions and insights into clinical applications. Frontiers in Human Neuroscience, 2022, vol. 16, article 747215. DOI: 10.3389/fnhum.2022.747215
  44. Peters S.A.E., Huxley R., Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes. The Lancet, 2014, vol. 383, no. 9933, pp. 1973–1980. DOI: 1016/S0140-6736(14)60040-4
  45. Pettit J.M., Noll J.D. Cerebral dominance in aphasia recovery. Brain and Language, 1979, vol. 7, no. 2, pp. 191–200. DOI: 10.1016/0093-934x(79)90016-6
  46. Saur D., Lange R., Baumgaertner A. et al. Dynamics of language reorganization after stroke. Brain, 2006, vol. 129 (pt. 6), pp. 1371–1384 DOI: 10.1093/brain/awl090
  47. Schevenels K., Gerrits R., Lemmens R. et al. Early white matter connectivity and plasticity in post stroke aphasia recovery. Neuroimage. Clinical, 2022, vol. 36, article 103271. DOI: 10.1016/j.nicl.2022.1032712
  48. Schramm J., Delev D., Wagner J. Seizure outcome, functional outcome, and quality of life after hemispherectomy in adults. Acta Neurochirurgica, 2012, vol. 154, no. 9, pp. 1603–1612. DOI: 10.1007/s00701-012-1408-z
  49. Stefaniak J.D., Geranmayeh F., Lambon Ralph M.A. The multidimensional nature of aphasia recovery post-stroke. Brain, 2022, vol. 145, no. 4, pp. 1354–1367. DOI: 10.1093/brain/awab377
  50. Stefaniak J.D., Halai A.D., Lambon Ralph M.A. The neural and neurocomputational bases of recovery from post-stroke aphasia. Nature Reviews Neurology, 2020, vol. 16, pp. 43–55. DOI:1038/s41582-019-0282-1
  51. Sternberg S. Modular processes in mind and brain. Cognitive Neuropsychology, 2011, vol. 28, no. 3–4, pp. 156–208. DOI: 10.1080/02643294.2011.557231
  52. Stockert A., Wawrzyniak M., Klingbeil J. et al. Dynamics of language reorganization after left temporo-parietal and frontal stroke. Brain, 2020, vol. 143, pp. 844–861. DOI: 10.1093/brain/awaa023
  53. Tao Y., Rapp B. How functional network connectivity changes as a result of lesion and recovery: An investigation of the network phenotype of stroke. Cortex, 2020, vol. 131, pp. 17–41. DOI: 10.1016/j.cortex.2020.06
  54. Turkeltaub P.E., Messing S., Norise C. et al. Are networks for residual language function and recovery consistent across aphasic patients? Neurology, 2011, vol. 76, pp. 1726–1734. DOI: 10.1212/wnl.0b013e31821a44c1
  55. Ulanov M.A., Stroganova T.A., Shtyrov Y.Y. Language rehabilitation in chronic post-stroke aphasia: A neuroscientific perspective. Journal of the Higher School of Economics, 2018, vol. 15, no. 2, pp. 232–245. DOI: 10.17323/1813-8918-2018-2-232-245
  56. Vallar G. Hemispheric control of articulatory speech output in aphasia. In G.R. Hammonf (ed.), Cerebral Control in Speech. Amsterdam, 1990. Pp. 387–416.
  57. Wawrzyniak M., Schneider H.R., Klingbeil J. et al. Resolution of diaschisis contributes to early recovery from post-stroke aphasia. Neuroimage, 2022, vol. 251, article 119001. DOI: 10.1016/j.neuroimage.2022.119001
  58. Wilson S.M., Entrup J.L., Schneck S.M. et al. Recovery from aphasia in the first year after stroke. Brain, 2023, vol. 146, no. 3, pp. 1021–1039. DOI: 10.1093/brain/awac129
  59. Wilson S.M., Schneck S.M. Neuroplasticity in post-stroke aphasia: A systematic review and meta-analysis of functional imaging studies of reorganization of language processing. Neurobiology of Language. 2021, vol. 2, no. 1, pp. 22–82. DOI: 10.1162/nol_a_0002510.1162/nol_a_00025
  60. Zaidel E. Language and the right hemisphere. In D.F. Benson., E. Zaidel (eds.), The Dual Brain: Hemispheric Specialization in Humans. New York: Guilford Press, 1985. Pp. 205–231.

Information About the Authors

Karine M. Shipkova, PhD in Psychology, Associate Professor, Leading Researcher, V. Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow, Russia, ORCID: https://orcid.org/0000-0001-8235-6155, e-mail: karina.shipkova@gmail.com

Vera G. Bulygina, Doctor of Psychology, Professor, Head of Laboratory of Psychohygiene and Psychoprophylaxis, V.P. Serbsky National Medical Research Center of Psychiatry and Narcology of the Ministry of Health of Russian Federation, Professor, Department of Clinical and Forensic Psychology, Faculty of Legal Psychology, Moscow State University of Psychology & Education, Moscow, Russia, ORCID: https://orcid.org/0000-0001-5584-1251, e-mail: ver210@yandex.ru



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