Language development and perinatal stroke, with Elissa Newport

In this episode, I talk with Elissa Newport, Professor of Neurology and Rehabilitation Medicine at Georgetown University Medical Center, about her work on the neural and cognitive underpinnings of language development, including statistical learning, language after perinatal stroke, lateralization, plasticity, the critical period, and more.

Saffran JR, Aslin RN, Newport EL. Statistical learning by 8-month-old infants. Science 1996; 274: 1926-8. [doi]

Newport EL, Landau B, Seydell-Greenwald A, Turkeltaub PE, Chambers CE, Dromerick AW, Carpenter J, Berl MM, Gaillard WD. Revisiting Lenneberg’s hypotheses about early developmental plasticity: Language organization after left-hemisphere perinatal stroke. Biolinguistics 2017; 11: 407-22. [doi]

Olulade OA, Seydell-Greenwald A, Chambers CE, Turkeltaub PE, Dromerick AW, Berl MM, Gaillard WD, Newport EL. The neural basis of language development: Changes in lateralization over age. Proc Natl Acad Sci USA 2020; 117: 23477-83. [doi]

Elissa Newport’s website

Episode Transcript

Stephen Wilson (00:06):
Welcome to Episode 17 of the language
neuroscience Podcast. I'mStephen Wilson and I'm a
neuroscientist at VanderbiltUniversity Medical Center. If
you're a regular listener, Iapologize for the delay between
episodes. It's been a busysemester, and I'm sure that
everybody can empathize. But Ihope you'll agree that this
episode is worth the wait. Myguest today is a living legend

(00:26):
of our field, Elissa Newport,Professor of Neurology and
rehabilitation medicine atGeorgetown University Medical
Center. Elissa is one of theworld's leading researchers on
language development. I'm goingto ask her about her seminal
work on statistical learning.
But our main focus today will beon her more recent line of work
on language outcomes in kids whoexperienced perinatal stroke.
It's very cool, very excitingwork mostly unpublished and I

(00:48):
hope you'll enjoy ourconversation. I'd also like to
say a big thank you in advanceto Marcia Petyt for transcribing
this episode, and to the journalNeurobiology of Language for
providing financial support fortranscription. As many of you
know, Neurobiology of Languageis a new open access journal
published by MIT Press, which isa nonprofit, and devoted to this
field. I'm a big fan of thejournal. I'm on the editorial

(01:11):
board. And I think it's a modelof the direction scientific
publishing needs to be going.
I've published two papers therealready, and I hope that you'll
consider sending your bestpapers there, too. I think we
should vote with our feet for anopen access nonprofit future.
Okay, let's get to it. Hi,Elissa. How are you today?

Elissa Newport (01:29):
Okay, how are you?

Stephen Wilson (01:31):
I'm good. Thanks so much for joining me on the
podcast.

Elissa Newport (01:34):
Thank you for inviting me.

Stephen Wilson (01:36):
It's like a cold rainy day in Nashville today.
How are things where you are?

Elissa Newport (01:40):
Nice. It's a little chilly, but sunny, very
nice in DC.

Stephen Wilson (01:44):
Alright. So, I was thinking we could get
started by talking about, Ialways like to ask people how
they became a scientist. So whenyou were a kid, did you always
know that you wanted to be ascientist? Or did that kind of
come later?

Elissa Newport (01:57):
Yeah. Later.
When I was a kid, I liked math.
I was good in math. But I alsoreally liked English, and I
wrote poetry and I was headedoff in a different direction.
When I started college, I was anEnglish major actually and then,
during college, I transferred. Istarted out at Wellesley

(02:21):
College, where the humanitieswere very strong and I was very
happy as an English major andwriting, and then I transferred
to Barnard College part ofColumbia University and the
English Major was quitedifferent, but I got interested
in psychology. So when I was inmy junior and senior years in

(02:42):
college, I started taking lotsof psych courses, and I became
the TA, the teaching assistant,for the undergraduate classes
behind me. I took care of therats in the Learning Lab. I did
experiments on learning, Istarted working at a place for

(03:06):
disabled people that involvedgiving them M&Ms and training,
toilet training them and soforth. And then I went to grad
school in my first year inClinical Psychology and quickly
decided that, that wasn't reallymy favorite area and ended up
studying language acquisition ingrad school.

Stephen Wilson (03:28):
Well, okay, so how did the switch to language
acquisition happen? Because thatwas obviously pretty pivotal for
you.

Elissa Newport (03:35):
Actually, what happened was that in my first
year at Penn in grad school, Itook a proseminar in
Physiological Psychology and oneof the assigned readings was
Eric Lenneberg, the EricLenneberg Science article
published in 1969, about thebiological foundations of

(03:59):
language, and I really kind offollowed the questions that he
raised forever since then. Thatwas a very, very important
article. I thought it wasterrific. I thought it was
fascinating. I wanted to studylanguage. I started going to see
aphasia patients with Paul Rozinand Oscar Marin and then I

(04:24):
decided I really needed to learnlinguistics. So I went to
Swarthmore College, where LilaGleitman was teaching
linguistics and took linguisticscourses from her.

Stephen Wilson (04:33):
Okay, well, I guess you just have a knack for
finding the right people.

Elissa Newport (04:38):
She was great and then I ended up deciding
that I wanted to work onlanguage acquisition with her.
So that actually is what I didfor the rest of grad school.

Stephen Wilson (04:50):
But she wasn't at Penn, so you kind of
collaborated acrossinstitutions?

Elissa Newport (04:54):
So at the time, there was a nepotism rule at
Penn, and Henry Gleitman was onthe faculty in the psych
department at Penn, and so hiswife Lila was not allowed to be
hired.

Stephen Wilson (05:06):
Okay. I guess that's one solution to the two
body problem. Maybe not a verygood solution.

Elissa Newport (05:14):
Yeah. She was the linguistics department at
Swathmore and later, she movedto Penn in the Ed school, again,
because she wasn't allowed to behired in the Psych department.
And then, sometime after that,they got rid of their nepotism
rules. It wasn't just Penn. Thiswas across the United States and

(05:36):
so they got rid of theirnepotism rules, and at some
point, Lila became part of thepsych department, but not while
I was a grad student. While Iwas a grad student, she was at
the Ed School, I think. It'shard to remember. But Henry and
Lila were jointly my advisors.

Stephen Wilson (05:54):
Okay! What great people to get trained by! And
that's so interesting for me tohear that you know, what really
got you excited about this fieldwas the Lenneberg paper. Because
obviously, we're gonna come backto that in a moment. But before
we kind of get on to our maintopic for the day which is your
work on perinatal stroke, Iwanted to kind of ask you about

(06:17):
the paper that made you famous.
I mean, well, you know, sciencefamous, which is "Statistical
learning by eight month oldinfants" by Saffran, Aslin and
Newport in 1996. One of the mostinfluential papers in
psycholinguistics of all time Iwould say. I was wondering if
you could tell me how it came tobe?

Elissa Newport (06:36):
Sure. Well, so when we started this work, Dick
Aslin and I were both at theUniversity of Rochester, and we
started working with JennySaffran, who was initially a
first year student with us. AndDick and I actually had
discussed before Jenny arrived,that she was interested in Word

(07:01):
segmentation, and word learningfrom her previous undergraduate
work and we had both read apaper by Hayes and Clark that
used a miniature language, itwas an artificial language with
non linguistic sounds to look atword segmentation following some

(07:24):
of the distributional work inlinguistics, and we decided that
would be a nice project forJenny to work on and so when she
came, we suggested that, as onepossibility for her. She was
very interested and so weimmediately started making some
artificial speech streams andlooking for synthesizers trying

(07:47):
to synthesize streams of speechand how to test whether people,
this was initially adults. So weran it first with adults, not
babies. There's a 1996 paperpublished in JVLVB, Journal of
Memory and Language later, thatis the word segmentation study

(08:12):
with a much more complicatedlanguage, much more complicated
words and statistics that wasdone with adults. So the first
study that we did together wasactually with adults. And I
should say, backing up, thatI've worked on miniature
artificial language learningstudies since 1980, or even

(08:32):
before my first paper, and thattopic was published in 1981. So
working on artificial languageswas not a new thing for me. That
thing, I'd been doing for quitea long time. I started working
on some artificial language workwith Jim Morgan. When he was a
grad student. He actually wasJenny Saffran's advisor in her

(08:55):
undergrad work. So there's allkinds of connections there.
Anyway, we started makingstreams of speech. We were very
interested in whether it wasthat people could really just
listen to streams of speech andacquire the structure of words

(09:18):
that they contain. But we didn'tat that time, have a formulation
about what later becamestatistical learning. It was
really one in a series ofartificial language experiments
that I had done but others werelooking at small grammars, small
syntax acquisition, and this onewas looking at word

(09:41):
segmentation. So sort of inbetween what Dick and I are
interested in. Dick usuallylooked at the sound stream, and
how babies and adults acquiredthe sound stream. I had been
looking at small syntax problemsand so there we were, sort of in
between and the wordsegmentation problem with
Jenny's interests. So she ranthat study with adults. It

(10:05):
worked great. That paper waswritten up and then Jen and Dick
thought they wanted to try asimplified version with babies.

Stephen Wilson (10:16):
I guess we should just make sure I think, I
mean a lot of people know thiswork. But just to kind of
clarify, the central challengethat you're kind of
investigating is, you know,words don't come with spaces in
between them, right? Like we,when we read, we, you know, we
see the words or, you know, withspaces between them, and they
kind of have their individualidentities. And that might sort
of mislead us into thinking thatthat's easy. But it's not easy,

(10:40):
because language is continuousand a big challenge for the
learner is to figure out wherethe where the boundaries are.

Elissa Newport (10:46):
That's right. So that was the problem. That was
the problem that we starteddeveloping in a miniature form,
that the actual acoustics ofspeech, natural speech, if that
there are no pauses and noprosodic cues to what are the
individual words. So, there wasa problem already in the

(11:07):
literature of how would babiesdo word segmentation? How would
they decide what the beginningsand ends of the words were
because they aren't signaledwith anything that you could
start with without alreadylearning the language. So, as
fluent speakers of a language,as fluent listeners, we hear
words as though there werepauses between them, but there

(11:28):
really aren't. There are somecues called pre-pausal
lengthening. So, under somecircumstances, the final
syllable of a word before apause, a quote unquote 'pause',
is actually lengthened and thatis perceived as though it were a
pause. But even pre-pausallengthening isn't an acoustic

(11:50):
cue that you could read, thatyou could use. So it wasn't
clear how people were doing wordsegmentation and the earlier
hypotheses were that you had toknow the meanings of the words
in order to pull them out of thespeech stream. So we were trying
to approach this as saying, no,there are certain even if you

(12:13):
have a completely continuousstream, even if you synthesize
the stream, so that we know forsure, there are no acoustic
cues, and there's no meaning atall. We think that babies and
adults might be able to pull outthe words, identify what the
words are as opposed to the wordboundaries, because they're

(12:35):
co-occurrences of whichsyllables are most frequently in
a corpus of speech comingtogether, those would be the
words, and which syllables fallacross a boundary, which would
be much lower probabilities,because the combinations of
words change all the time. So,that was what we were mocking up

(12:58):
in that synthetic speechstreams. In the adult language,
there were six words that hadlots of reused syllables and in
the baby language, we made areally simple version of it. So
that baby language was a secondstudy, we had already
demonstrated that adults coulddo it. But we knew actually that

(13:19):
people would be more impressedwith the abilities, if we could
show it in babies. So that'swhat we did and that paper was
published in Science.

Stephen Wilson (13:30):
Yeah, it sure was. So what does the stimulus
sound like?

Elissa Newport (13:37):
The stimuli sound like just continuous. The
ones that we presented to babiesare two minutes long with no
breaks.

Stephen Wilson (13:47):
Can you do a demo for us? Or is that beneath
your dignity? (laughter)

Elissa Newport (13:52):
No, I really can't. Jen Saffran is really
good. She's actually a singerand so she can do live demos of
this. I don't know if she stillcan, because it was 25 years
ago, that we did this study. Butno, it's synthetic speech and so
it has this kind of monotonecharacter. It's not really

(14:13):
monotone. There is some prosodyin the speech, but it doesn't
have anything to do with theword boundaries. We used the
natural speech synthesizer, butall the syllables were edited to
be about the same length andthey had no prosody no acoustic
cues, the word boundaries, sothey have a more natural

(14:35):
quality, but they're prettymonotone and it just goes on for
two minutes without a break. Ican play it for you if you want,
but I'd have to find thestimuli.

Stephen Wilson (14:46):
Well, you know, I guess I'm just gonna have to
take it upon myself to imitatehow I think it sounds, which is
something like "Bali goo pa Ligatula bardi goo pa bardi". like
that, right?

Elissa Newport (15:01):
That's right. Uh huh. Good for you. (laughter)

Stephen Wilson (15:04):
I'm not happy that I had to do that, but
anyway... (laughter) Okay, soyou play that to the infants and
yeah, what do you what did youfind?

Elissa Newport (15:15):
Well, so we played this continuous stream
for two minutes. In the adultversion, it was a much more
complicated statisticalorganization, because the
syllables were reused indifferent words, which is more
like real languages. In the babyversion, there were four words
and each syllable appeared onlyin one word. So there was a very

(15:38):
high consistency of how thesyllables were organized inside
the words and then at theboundaries, it was random choice
among the other three words. So,they're what we thought of later
actually, not when we originallydesigned it, is that you could
identify a very specificstatistic that would allow you

(16:02):
to group the syllables intowords, if you were keeping track
of the recurring sounds and ifyou were keeping track of the
statistics of the corpus. Whenwe originally did it, we just
said well, this is like thestructure of words, we're going
to sequence them continuouslyand so the features of words

(16:23):
should lead you to be able topick out the words from
listening. But we didn't have aparticular heuristic that we had
identified as what participantsmight be using. But what happens
in both babies and adults isthat after a certain amount of
exposure, we then give thembasically a two alternative

(16:45):
forced choice, we give them achoice between words, and what
we call part-words, which is theend of one word and the
beginning of another. Those arevery very similar, they both
occur in the stream of speech,but one of them has a more
coherent high probabilitystatistic binding their
syllables together across thecorpus, which is the words and

(17:06):
the part words have a lowertransition at the boundary. What
we ask adults is to pick out theone that sounds most familiar
and what we look at in babies,is how long do they look at a
speaker that's speaking, thewords or the part-words. The
result is comparable. Babieslook longer when it's a

(17:29):
part-word. So they're showing anovelty effect and that tells us
that they've identified thewords, that those are more
familiar to them by the end oftwo minutes.

Stephen Wilson (17:41):
Yeah, it's an incredible finding and I can see
why it made such a splash. WhenI look back at that literature
from the late 90s, after you allpublish your paper, it seemed
like it stirred up a lot ofdebate. Some people interpreted
this like incredible learningability that you had
demonstrated as evidence againstthe Chomskian notion that
language is innate and theChomskians pushed back and said,

(18:04):
it actually has no bearing onour claims. What did you think
about all that?

Elissa Newport (18:08):
We actually wrote one of the responses. So
the paper was initiallypublished in Science. Then there
was a series of letters thatwere written to the editor of
Science, one of which was fromus. So, Liz Bates and Jeff Elman
wrote a paper saying, we alwaysknew that Chomsky was completely
wrong, babies can learn anythingand this demonstrates that you

(18:31):
don't need anything innate inorder to learn languages. And we
actually wrote back and said,that's not what we think at all.
We wrote in and said wordsegmentation certainly requires
exposure to the language andthis, what we're demonstrating
is that you can acquire thedistributional cues from words.

(18:54):
But we did not mean to say thatthose same kinds of analyses
could learn an entire language.
That's not true and we disagree.
We think that learning is acombination of innate biases
about what kinds of statisticsyou can compute what kind of
structures language willpresent, and the ability, the

(19:16):
extraordinary ability of humans,especially babies to learn from
input. So we think it's acombination of nature and
nurture, and the chomskians allwrote you know, more strongly
than we even but we agreed witha lot of what they said. This
experiment doesn't demonstratethat. I also corresponded with

(19:40):
Noam Chomsky, actually. When thepaper was in press, we learned
to our surprise that aperspectives article about the
paper was to be written by LizBates and I guess it was Liz and
Jeff together. But we were nottold that they were asked to do

(20:03):
this. We wouldn't have askedthem in particular, to do this.
And we never saw theperspectives article before it
went to print. It presented ourfindings in a way that we would
not have agreed with actually.
So we were actually quite upsetthat our article was being
presented in a context that wehad no control over. But I

(20:26):
thought it would be prudent tosend the paper to Noam and say,
hey, look, here's our paper. Wehope you really like this. But
the perspectives article isn'twhat we ever meant. So, I just
wanted to give you a heads up.

(20:46):
And Noam wrote back right away,and said the work is great. I
think it's really cool.
Actually, look at a footnote inmy 1955 paper where I suggested
that this could be done. And hedid! (laughter)

Stephen Wilson (21:02):
Oh, that's classic. (laughter) Yeah, that's
an interesting choice that they,you know, went such an
opinionated direction for thecommentary, but I guess....

Elissa Newport (21:13):
Liz told me later that she was one of the
reviewers of the paper when itwas published in Science.
There's an editor of Science whoworks and works on editing the
papers that come in, in ourfield. And he was the one who
asked Liz to review the paperand then asked her to read the

(21:34):
perspectives article.

Stephen Wilson (21:36):
Yeah, well, I know that she always loved the
paper, regardless of whether youguys had a disagreement over how
it should be interpreted.

Elissa Newport (21:45):
Yes. Actually, the reason I went back and forth
about this, because I tried toargue to her at the time that if
you're going to read aperspectives article about
someone else's work, you shouldbe respectful and what they
said. And she disagreed. Webecame really good friends again

(22:09):
when she got ill and I wrote toher and said, you know, none of
this matters when someone's illand we're colleagues. I had a
long correspondence with herbefore she passed away.

Stephen Wilson (22:21):
Yeah. She really liked the back and forth of
scientific debate and she wasalways willing to, you know, put
it aside for the personal.
So....

Elissa Newport (22:32):
I also became very good friends with Jeff
Elman, who I also miss a lot.

Stephen Wilson (22:36):
Yeah, he was a lovely guy. Okay, cool. So, I
know that you continue this veryproductive line of research on
statistical learning, like tothe present day. But I'd like to
shift gears now and talk abouthow you got into neuroscience.
So sometime in the last decade,I don't know exactly when you
evidently decided to take yourresearch in a new direction and

(23:00):
start studying language inpeople with perinatal strokes.
What made you decide to, youknow, shift what you're focusing
on?

Elissa Newport (23:10):
Well, I've always been interested in the
nature/nurture issue and incritical periods. In particular,
like what is special about theway that children learn language
that doesn't continue in thefull form, throughout our lives?
What is it that makes childrenso gifted at learning language?
The original Lenneberg argument,as I read in my first year in

(23:33):
grad school, is that there was acritical period and he included
in that, in his mustering ofevidence for a critical period,
that there was extraordinaryrecovery from injury to the
brain in children that was quitedifferent than what you see in
adults. He had done that, hecollected evidence on that

(23:59):
topic, by going through patientsthat weren't accessible to him
and by going through theclinical literature, looking at
case reports. And so in hisbook, and in that Science
article, he has a kind of tallyof cases that were injuries to

(24:20):
the left and the righthemisphere at different ages,
and how recovery looked, howwell did the language come out.
They were just classified asgood or not good, are impaired
or not impaired. And theargument that he presented from
those data, is that, when you'rea baby, damage to the left and

(24:42):
the right hemisphere are equallylikely to intrude on language
acquisition. And the argumentwas also made that if you get
damaged to the left hemispherelanguage would recover in the
right and that gets less andless true as lateralization of
function develops to the lefthemisphere in the healthy brain,

(25:04):
you no longer see recovery,perfect recovery with injuries
and you no longer see a shiftingof language to the right
hemisphere. So that was alreadyin the literature. I worked for
a long time on issues aboutcritical periods and whether
people really did show acritical period for second

(25:25):
language learning and also forfirst language learning. But all
of the previous work I had donewas behavioral. But when I was
at Rochester, I was the chair ofthe department of Brain and
Cognitive Sciences and so Iinteracted lots with people in
the Medical Center, and becamecolleagues with people who were
in neurosurgery and inneurology, got interested in

(25:51):
actually looking at thisoriginal phenomenon of
Lenneberg's. But I couldn't dothis work in Rochester. There
aren't enough.... I meanperinatal stroke is very rare.
There is not the caseload inRochester to do that kind of
work. But then I was offered ajob at Georgetown to come and

(26:12):
start a center on brainplasticity and recovery. And I
was very anxious to start movinginto doing the neuroscience part
of brain plasticity, and reallylooking at changes over age in
injury and recovery. So Iaccepted the job at Georgetown
and I got NIH offers one Kaward, it's K18, that is for

(26:39):
senior investigators to havementored training in a new
field. So I actually had appliedfor this K aword, I eventually
got it, and I was mentored fortwo years by a bunch of
neurologists, pediatricneurologist and stroke

(27:00):
neurologist here. At Children'sNational Medical Center, I went
to clinic for two years, I wenton rounds and at Georgetown. I
sort of did the whole thing,digging into learning about
neurology,

Stephen Wilson (27:14):
And who were your key mentors on that?

Elissa Newport (27:18):
My main mentor was Alex Dromerick, who was the
Chair of Rehab Medicine and myCo-Director of the Center for
Brain plasticity. Also PeterTurkletaub, who's in the
Department of Neurology here andthey're both stroke neurologists
and adults. And then I met BillGaillard, at Children's National

(27:41):
Medical Center. He's the head ofchild neurology. And I met
Jessica Carpenter, who at thattime was also at Children's
National Medical Center. And Iwent to stroke clinic at
Children's with JessicaCarpenter for two and a half
years, and went once a week andsaw all the kids who came in
with a stroke and so forth. Andthen Alex and Peter were, really

(28:07):
Alex, really helped me todevelop a line of research and
understand how you do recruitingwith MDs and how you get the
right team of people involvedwhen you do a big study like
we've turned out to do.

Stephen Wilson (28:22):
Yeah, I just, I just love this story that you,
you know, basically, likecompletely retrained in the new
kind of science after having,you know, an ongoing and
successful career doing adifferent kind of science.

Elissa Newport (28:34):
So I've done this before. I, I mean, I know
it sounds unusual, because I'm,of course aware that most people
don't do that. But I actually doit every 15 years or so. When I
was a grad student, I worked onlanguage acquisition and
mothers' speech to kids inEnglish and of course, and then

(28:55):
my first job when I got out ofgrad school, I was really
interested in learning signlanguage. And so I took a job at
UCSD, I was lucky to get anoffer at UCSD, which was right
across the street from UrsulaBellugi's lab at Salk Institute,
and learned to sign. Learnedsign language for quite some

(29:15):
time I met my husband, Ted,who's deaf and a native signer
and I worked on sign language,which I had never worked on
before for quite some time andstill do a little. And then I
started doing artificiallanguage learning work and did
statistical learning work andthen I moved into working on

(29:38):
perinatal stroke. But for me,it's all been part of the same
picture. All about sort ofwhat's special about kids and
what's special about languageacquisition.

Stephen Wilson (29:48):
Yeah, now I see the connection. It's not like
you're working on a randomcollection of disjointed topics,
but it's just different skillsets and I think that's really
remarkable.

Elissa Newport (29:57):
It's very very fun. I mean, I think wouldn't be
bored if I stayed working on thesame thing. I really love
learning new things and beingable to be sort of a grad
student or a postdoc over andover again.

Stephen Wilson (30:12):
Yeah, I get that. I mean, that's kind of the
fun time in many ways, isn't it?

Elissa Newport (30:17):
Yes.

Stephen Wilson (30:18):
It certainly where the, you know, the slope
of acquisition of knowledge issteepest. So if you enjoy being
on that steep part of the slope?

Elissa Newport (30:26):
Yes!

Stephen Wilson (30:26):
That's a good strategy. So let's talk about
what you've learned from thisline of work. So can you tell us
about these perinatal strokepatients like Who are they like,
what's the incidence of it? Dothey have other health problems?
Like what is it?

Elissa Newport (30:41):
So I'm at the beginning of any discussion
about this way back withLenneberg, for example, I think
people didn't really know thatthere was much a stroke in
children. So Lenneberg justtalked about brain injuries. But
in much more recent years,investigators who work on

(31:04):
pediatric neurology have putdata together from around the
world and discovered sort ofwhat are the syndromes. So this
has been much more slow goingand required a kind of worldwide
collaboration. Gabrielle deVeberis one of the central people
who's organized this. Becauseany kind of stroke in children

(31:26):
is very rare, it hasn't beenreally known until recently,
what exactly you could call themain cluster of syndromes.
Perinatal stroke, is a type ofischemic arterial stroke. So
this is a clot in an artery thatreduces blood flow or stops
blood flow to a particular areaof the brain, just like most

(31:50):
strokes in adults. Strokes areeither hemorrhagic so
hemorrhages, or clots and forscientific purposes, it's much
better to look at a clot kind ofstroke, because you can predict
the area of damage. A hemorrhagegoes all over the place. Blood
is toxic to the brain and sohemorrhages are much less

(32:13):
circumscribed. So this isperinatal stroke is a type of
stroke that occurs right aroundbirth, it's usually the kids
that we study usually have theirstrokes within a few days of
birth. It's rare but relativelycommon compared with other kinds
of strokes and babies, whichdon't happen much. Because birth

(32:38):
is really hard on the brain. Andit's has lots of effects and
other systems. Nobody knows whatcauses perinatal strokes, but
they're one out of 1000 or 3000.
Somewhere in that neighborhood.
People don't know sometimespeople say one out of 4000 live
births. So the incidence isn'tquite known, but that puts it

(33:01):
rare but not super rare. It'smuch more common than childhood
stroke, childhood stroke isalmost unheard of, because
babies don't have any childrendon't have any plaque in their
arteries. And that's what causesstrokes later. So the most
common stroke at perinatal timeis a left hemisphere middle

(33:22):
cerebral artery stroke, whichmeans it's the left hemisphere
territory, that pretty much islanguage in the adult.

Stephen Wilson (33:34):
So why left? Why is there a hemispheric
difference?

Elissa Newport (33:38):
The hemispheric differences due to the way the
arteries ran out of the heart.
So in adults, stroke materialplaque comes from the carotids
and it's evenly distributed onleft and right. But when it's an
embolism coming out of theheart, there's a straight path
to the left and much morecomplicated path to the right.

(33:59):
And so we see the consequencesof this. Most of the kids that
we see have left hemisphere,middle cerebral artery strokes,
the middle cerebral artery isthis big artery that serves most
I mean, it serves most of thefrontal and temporal lobes. And

(34:20):
it's mostly left for the reasonsthat I just said and so those
are the really common ones. Wehave a lower incidence of right,
middle cerebral artery strokes,and so we're looking at kids who
have either right or left butnot both. So that is their kids
who have one injured hemisphere.

(34:43):
It could either be to theanterior or the posterior
regions of that territory or thewhole territory. And so we've
got a mixture. We are looking atpretty big strokes, so we
eliminate people, kids who havelittle teeny, weeny strokes.
Many of these kids, because thisis a birth injury that results

(35:08):
after a normal pregnancy, theydon't have other disorders. They
were healthy until the time ofthe stroke. The pregnancies were
full term and healthy. So theydon't typically have other
disorders, except that there areconsequences of having a stroke,
of course and once you have astroke, there are some higher

(35:30):
likelihood of seizures. And sowe we look through the medical
records and try to make surethat we get kids who are not
having a high seizure burden orany seizures if possible.

Stephen Wilson (35:43):
Right. I mean, a lot of these kids, it's not even
known at the time that they hada stroke, right?

Elissa Newport (35:49):
That's right. So if they have a seizure, in the
hospital, in the nursery whenthey're born, and then they get
sent for imaging, but otherwise,babies don't get imaged. So
nobody knows that they had astroke, and newborns, their
movements are not criticallycontrolled. So even if they have
a big stroke to the motor areas,you're not gonna see asymmetric

(36:13):
movement, you're gonna seeperfectly symmetric movements.
So later, as the cortex startsto control motor activity, kids
who have a stroke to the motorregion will show an impairment
of movement on the opposite sideof the body, but at birth, that
won't show up. So if they haveseizures in the nursery, which

(36:35):
sometimes happens maybe a thirdof the time, they get sent to do
imaging, and you can see thestroke on imaging. If they don't
have any abnormal behavior, thenthey go home, and they're
perfectly healthy and then themom starts to notice as they get
to be like three, four monthsold, that they're not using the
right side of their body. Andthen they'll get taken back to

(36:58):
the pediatrician, oftenrepeatedly, with pediatrician
saying, Oh, you're just ananxious side...

Stephen Wilson (37:04):
You are just paranoid.

Elissa Newport (37:06):
And then they'll do imaging and see a big stroke.

Stephen Wilson (37:09):
Well, and then I'm guessing, like, if it
doesn't affect the motor area,like it may often not be
discovered at all untilincidentally, much later, if
not, never.

Elissa Newport (37:20):
Yeah, I mean, a lot of them affect motor
behavior and so the kids that wesee, we have chosen to look at
kids when they're much, mucholder, I've wanted to look at
the outcome, long term outcomeand so we recruit kids who have
had a perinatal stroke at age 12or older.

Stephen Wilson (37:43):
Right. So yeah, is that a practical decision
that you made to focus on that,you know, kids 12 and older?

Elissa Newport (37:51):
No, it's impractical and we would have a
much easier time if we followedthem in early childhood, because
that's actually when they'reidentified. What we have to do
to find them later is go backinto medical records and then
try to contact people 12 yearsafter they were at the hospital.

(38:11):
So we actually have a muchharder time finding them. I see
kids in the clinic when they'relittle, but they don't have,
they don't necessarily continuegoing regularly to see the
neurologist because they don'thave neurological problems
typically. So in the healthiestcases, they'll see a neurologist

(38:33):
in the first few months, andthey'll get physical therapy,
because if they have a motorimpairment, they need to have
physical therapy, sometimesBotox in the muscles, and so
forth and then they're okay. Andthey get seen again when they're
at preschool, because they needto have neuro psych exams for
school. And then they go intoschool and typically, by the

(38:58):
time they get to be adolescents,they often will have extra time
on tests, but they're at gradelevel. I mean they're
cognitively normal. They haveexecutive function impairments
that are pretty common. So theywill have a little bit of
reduction in short term memory,they'll have extra time on

(39:20):
tests. They're a little slowerIf you give them a speeded task,
a fluency task, they're a littleslower. But otherwise, they're
actually perfectly normal kids.

Stephen Wilson (39:33):
Yeah, I mean, so let's kind of like get to the
very central observation of thiswhole line of work. I mean,
how's their language?

Elissa Newport (39:41):
So, it is reported in literature actually
by Liz Bates. Liz Bates workedin this field also. She looked
at the young children and whatthey were finding when they
followed kids with perinatalstrokes younger, is that the
left and the right hemispherestrokes have equal effect on

(40:02):
language. But they are somewhatslow in their language
development. When we look atthem as adolescents and young
adults, their behaviorallanguage tests look totally
normal. Totally normal. And thisis focusing on tasks that test
complex sentence, for example ifyou give them tasks that include

(40:28):
executive function. So there arestandardized tasks that give,
you know, put phrases on cardson the table. Now make as many
sentences as you can. I mean,that requires problem solving,
and memory and so forth, notjust language. The right and the

(40:48):
left are a little impaired onthose, they're on the low side
of the normal range. But if yougive them just ordinary sentence
comprehension tasks, onlinesentence comprehension,
perfectly normal, like theirsiblings, that's their controls.
And if you give them productiontasks, like we use the frog

(41:08):
story, they see a picture bookthat has no sentences written
down, it's just pictures, andthey have to tell the story. And
then we record them and givethem to speech pathologists for
scoring. There's no differencein their speech from their
siblings, either. So by the timethey get to be adolescents and
young adults, eliminating theones that have severe seizure

(41:32):
disorders, we don't see them.
But the ones who are otherwisehealthy and they do occasionally
have seizures, but not hugenumbers of seizures, they're
breakthrough seizures sometimesthat have to do with having had
a stroke. Their language isperfectly normal.

Stephen Wilson (41:52):
Yeah, so it's a pretty stunning finding. I mean,
like, you know, if you don't, ifyou're not Lenneberg, it's not
maybe surprising, but I think ifyou I think it's kind of
surprising for most people tolearn this.

Elissa Newport (42:04):
It is. It is really, I mean, especially if
you look at their imaging. Ieven hate to show their parents
their imaging, because parentsdon't usually know how to read
an image they might have oncebeen shown. But if you look at
the image of their brain, theseare very large strokes that
we're seeing and we have oneyoung lady that we've studied,

(42:28):
who's lost her entirehemisphere, from a stroke and
they just look kind of shocking.
If you look at them visually,there's so much brain tissue
missing. But their language isreally in the language
hemisphere, in the normal, lefthemisphere language centers, but
their language is quiteunaffected and if you talk to

(42:51):
them, you would never know thatthey had a stroke that perfectly
normal to interact with.

Stephen Wilson (42:57):
Yeah, it's kind of amazing.

Elissa Newport (42:59):
It really is.

Stephen Wilson (43:00):
So now, you have the ability to do something that
Lenneberg could never do. Oreven Broca, as I'm sure, you
know hypothesized, had onepatient along these lines and
hypothesize the, you know, whatwas going on. But you actually
have fMRI, and you collaboratewith Bill Gaillard and he has

(43:21):
this task called the auditorydefinition decision task, which
you use to map language in thesekids.

Elissa Newport (43:28):
Yes.

Stephen Wilson (43:28):
Can you tell us about that paradigm, why you
chose it?

Elissa Newport (43:32):
Yes. So this is a paradigm that Bill Gaillard
and his group have been usingfor some time with epilepsy.
Bill is the chief of epilepsy atChildren's. He's one of the
collaborators that I mentionedearlier and so they focus on the
effects of epilepsy on thebrain. And they have developed

(43:54):
this task. It's highly reliable,and a lot of times they use this
task at Children's before theydo surgery for removing
epileptic fossa. So they can useit that the normal procedure and
adults used to be that you hadto do open brain surgery to

(44:16):
figure out where focuses but youcan use imaging instead. The
task is there, it's a blocktask. There are blocks in which
the listener lying in thescanner will hear a series of
sentences like a big grayelephant, sorry, a big gray

(44:36):
animal is an elephant and theyhave to push a button if it's
true. Or a big gray animal is achair and they are not supposed
to push the buttons. So there'sblocks of sentences, some of
which are true and some of whichare silly as we tell the kids
and they're supposed to push abutton when they hear the true

(44:59):
one. That is to provide evidencethat they're listening and
evidence that they're doing okayand processing the sentences
during the blocks. And that is,we do scanning during those
blocks. And then that iscompared to other blocks that
are randomly presented, thathave the same audio sequence

(45:22):
backwards. And so the backwardsspeech has all the auditory
properties of the sentences, butit's not comprehensible. So if
you look at the parts of thebrain that are calling for blood
flow, and that are active duringthe forward sentences, and then
take away the areas that arecalling for blood and active

(45:44):
when you're just listening tobackward sentences, and they
don't mean anything. Thedifference are to beat those
regions of the brain that areactually involved in
comprehension of the speech. Sothat's what Bill uses to do his
epilepsy studies. We picked itbecause it's very reliable. This
is something that you have beenworried about Stephen in your

(46:06):
own work. We wanted a task thatwas very reliable, so consistent
that we could do it withindividuals. So we do all the
analyses of individual kids, wedon't need to just do groups.
And what you find in a healthypopulation is that this lights
up pretty much the entire lefthemisphere language network. So

(46:30):
it's a big activation that youget in both frontal and
posterior regions in the healthybrain. In the perinatal stroke
kids, if you get any part of thebrain that has a big impairment,
you see all of the languagenetwork in the right hemisphere.

Stephen Wilson (46:49):
So the whole thing just shifts over.

Elissa Newport (46:52):
Yup! And it's not, I mean, parts of it don't
shift and you don't havelanguage impairments as I
already said. In an adult, ifyou get damage to one region,
the skills that that areacontrols are impaired. That's
the typical outcome. Totallytypical in adults. In kids,

(47:15):
apparently if you get any partof the language network showing
pretty big infarct, they justdon't use that hemisphere for
language. The healthy hemispherethen wins even though it's not
the dominant hemisphere in mostpeople. It seems at birth, to be

(47:39):
just having some kind of strokein the left hemisphere puts it
at a bigger disadvantage thanthe right and language is
acquired in the right. Thisshows up in everyone except one
of our kids, who has a very tinyinfarct.

Stephen Wilson (47:54):
So the kid with the tiny infarct, did language
just stay in the infectedhemisphere. I mean, the left I
guess?

Elissa Newport (47:59):
Yes. Well, it's really bilateral in this
particular kid. We have otherkids.

Stephen Wilson (48:04):
That's kind of weird.

Elissa Newport (48:07):
Yeah, I mean, I don't we haven't looked
particularly closely at thatchild. But we need to dig in to
how that child... But you seebilateral activation in healthy
kids.

Stephen Wilson (48:21):
You know, in kids with epilepsy, I know that
you occasionally see theseinteresting cases with what you
see a dissociation with frontalareas in one hemisphere and
temporal areas in the other. Doyou ever see that in perinatal
stroke or no?

Elissa Newport (48:35):
No. They see this in a very small percentage
of the epilepsy kids. So withchronic epilepsy of the left
hemisphere, about 20% of thekids show any sort of atypical
language organization, so 80%,maintain language in the left

(48:55):
hemisphere, even if it's notperfect language, which is the
usual outcome. So epilepsy, evenchronic seizures throughout
childhood seem to have a kind ofmilder effect on which
hemisphere is going to bedominant than stroke. In our
data, if there's a stroke, itjust never develops in the left

(49:16):
hemisphere. So that's aninteresting contrast that we're
actually looking at furtherthese days.

Stephen Wilson (49:23):
Yeah it's really interesting. So I guess your
data indicate that my plasticityfor language is really quite
highly constrained, right? It'snot that language just goes and
uses parts of the lefthemisphere that were undamaged.
It really only has one othermajor option, which is to have
the same layout, but in theopposite hemisphere.

Elissa Newport (49:43):
That is exactly what we find very plastic and
very constrained.

Stephen Wilson (49:48):
Yeah. So why do you think that is? Why are there
only these two symmetricaloptions?

Elissa Newport (49:52):
I think that's a really good question. I don't
know. There's something aboutthose two hemispheres. Now, one
factoid here is that, if youlook at kids, healthy kids who
are age four, five, they alsoshow activation of these two

(50:14):
networks. It's not symmetric atfour and we would like to go
back farther and look at earlierstages where we expect that we
would see more symmetry. Butthere is much more activation of
the right hemisphere homotopicregions in very young children
than there is in adults. By thetime they get to be adults, that

(50:37):
right hemisphere activity haspretty much shut off of the
tasks that we use for sentenceprocessing tasks and instead,
it's used for a different aspectof language. So you find right
hemisphere homotopic activationfor a network that does
emotional prosody, for example,which is another task we use.

(50:57):
You identify the emotions in thevoice, is the voice expressing
happiness or sadness, etc. So inthat task, you see the light up
of the right hemisphere andhealthy population. So, in an
adult, both hemispheres are usedfor language, but they've been
assigned different functions.
They've developed differentfunctions, contrasting

(51:19):
functions. In the perinatalstroke kids, both functions are
in the right hemisphere, if youhave a left hemisphere stroke,

Stephen Wilson (51:29):
Right and that doesn't tend to come at any kind
of cost?

Elissa Newport (51:32):
No. Not..I mean, the tasks that we've done so
far, they do both equally wellto their siblings. They do
segregate these regions. So, tosome degree, they are non
overlapping in the samehemisphere. It's not like
they're using the same tissuefor two different things. They
each find their regions.

Stephen Wilson (51:53):
Right. I think he presented some preliminary
data on that at SNL a couple ofyears ago, but this is that's
not published yet, right?

Elissa Newport (52:00):
No, this is, we're just still reading this up
now. There are a couple ofdifferent papers. So, I'm
writing up the overall findingsof both tasks and Kelly Martin,
one of our neuroscience gradstudent is working with myself
and Peter Turkletaub, BillGaillard and Anna Greenwald, has
been looking at the homotopicrelations between the

(52:23):
activations and has evidencethat these are really, truly
homotopic and also, that if youlook at the activation of these
two tasks that are in onehemisphere, and the perinatal
stroke kids, that they're moredistinct regions, then you find
if you just flipped over thehealthy activation of the

(52:44):
healthy sibling.

Stephen Wilson (52:45):
Wow, that's super cool. I can't wait to see
that in its published form. Iguess I should mention that, you
know, that the finding you justalluded to about the sort of
increasing lateralization withage is published by your group
Olulade et.al. 2020, PNAS. Imean, in my reading of that

(53:06):
paper, you know, like,certainly, I think your youngest
kids were four and a half to sixand a half ish, and they were
pretty lateralized already. Imean, I agree with you, I mean,
you know, you definitely havestatistical evidence that
they're not as lateralized asadults. But they're pretty,
pretty lateralized.

Elissa Newport (53:21):
Absolutely, I agree. Totally. And we've done
the comparable analysis. Sosorry, let me just address that
point first. So, yes, and wewould love to look at kids
younger, the reason that thosedata go, only started four and a
half is because that those scanscome from Bill's group and

(53:45):
that's about as young as you canget kids to hold still in the
magnet. Now, Nick Turk-Browne istrying to do infants who are not
sleeping in the magnet. But ofcourse, movement is always a
problem when you're doing fMRI.
So there are some restrictionson being able to work with the
very young, and the data onneonates and language, healthy
neonates and language, basicallydoesn't look at the relative

(54:10):
activation of the left and theright hemispheres. People have
been interested in whether therewas any lateralization, but not
to what degree. So that is anunaddressed question that we
would like to look at. But wehave been doing the same kinds
of analyses in visual spatialtasks and in emotional prosody.
So these are now righthemisphere tasks in the adult

(54:37):
and looking at young children,and so we have two papers. One
of them just appeared in one ofthem in press in Developmental
Science, looking at two visualspatial tasks and in a line by
section task, for example. Thisis Katrina Ferrara as the first

(54:59):
author Barbara Landau is aco-author. And in this, in the
healthy person, a vertical lineby section task activates, right
hemisphere, parietal areas. Inchildren, it's bilateral, and
it's more symmetric. So we'reactually starting a line of
work, me and Barbara Landau andAnna Greenwald looking in

(55:24):
healthy kids at the developmentof lateralization for these
various skills and trying tofigure out, you know, is
language always much morelateralized? Are we not picking
it up early enough? Is there adevelopmental change in language
before visual spatial? Or isthere the same pattern of
lateralization developing? Butin all of these regions, we find

(55:50):
some degree of bilateralactivation in all of these tasks
in young children, and much,much more lateralized function
as they get older and get to beabout 10.

Stephen Wilson (56:04):
Yeah. It's such a mystery, you know, and it
really makes me wish that wecould scan really tiny babies
and then they went souncooperative?

Elissa Newport (56:15):
Yes, yes. Well, I, we are sending stimuli to
Nick, who has to figured out howto do this. So let's see how
that kind of behavioral datacomes out. I hope if Nick is
willing to try our stimuli.

Stephen Wilson (56:31):
Yeah. Cool. So you've kind of given us some
outlines of, you know, thepapers that you've got in
preparation or in press. What'snext for this line of work?
Like, what are the, what are yougoing to be doing next?

Elissa Newport (56:46):
Well, so they're, they're a bunch of
things that we've alreadycollected scans on that are now
still being analyzed. And one ofthem is that we've been looking
at the organization of theinferior temporal lobes, which
are object specific areas in thehealthy brain. So for example,

(57:07):
what happens to the organizationand lateralization of the
fusiform face area and thevisual word form area and the
the parahippocampal place area?
These are famous areas that arein the inferior temporal lobe,
part of the high level visualsystem but or the mid level
visual system. But but it's notdamaged by a middle cerebral

(57:30):
artery stroke. So the kids whohave lost chunks of the left
hemisphere or the righthemisphere, MCA territory still
have both inferior temporallobes healthy. So then one can
ask, well, where does the visualword form area go? Does it go to

(57:51):
its usual place in the lefttemporal lobe? Or does it go
with spoken language abilitiesin the right?

Stephen Wilson (58:03):
And that's where I'm going to put my money?

Elissa Newport (58:05):
That's the outcome, yes.

Stephen Wilson (58:08):
It wants to hang out with its friends.

Elissa Newport (58:11):
That's right. So all of this suggests that there
are principles of how networksform that have to do with
locality. You asked earlier,like, how many times do you see
the split between the posteriorregions and the anterior regions
of language? And it's veryuncommon, I guess it's possible
because Bill sees it sometimesbut the language network parts

(58:36):
seem to like to be together. Andthat's obviously the same with
the visual word form area.

Stephen Wilson (58:43):
I do believe, you know, Bill's data, because I
think his task is really solid.
But I've never... I've scannedmany epilepsy patients, and I've
never seen it myself. So it'sgot to be super rare.

Elissa Newport (58:56):
That's right. I think so. Even in their data.
It's just a couple of people. Ifyou look at how many people end
up in that cell of their...

Stephen Wilson (59:05):
Yeah, but I think that I mean, they've
studied hundreds of people. Sothat's why they're gonna see a
few.

Elissa Newport (59:09):
That's right.
That's right. But that's notgenerally the way networks form
best, apparently. And so this isalso in line with what standard
Hans group and Jocelyn LambadaHan have argued that that the
visual word form area isrecruited as something that lies
that has to lie between highlevel vision and language. And

(59:33):
so it travels with withlanguage, high level visions on
both hemispheres. So that's onething that we have collected the
data on and still in progress.
One of our grad students isMaddie Marcelle is a

(59:53):
neuroscience MD PhD studentwho's just starting to do some
white matter analyses. We don'tknow for the stroke kids and for
the epilepsy kids that Billstudies, which of these kids
have white matter tract injuriesthat would ruin the connectivity

(01:00:14):
between different parts of thelanguage system. And so that's
an important anatomical andphysiological addition to
looking at this. But the sort ofnext bigger step that I would
like to take is number one,looking at this issue of healthy
development. How does healthythe healthy development of

(01:00:35):
lateralization work? Why arethese areas particularly
organized the way they are?
What's special about in thenormal brain about what becomes
language? And what doesn'tbecome language? Why do these
areas become language? I thinkit's not, many people often
suggest when I talk about this,oh, it's because of the regions
of the mouth and ear but thatsame language area work for sign

(01:00:58):
language. So that's not theright answer. So we want to
understand healthy developmentas a background and constraint
on how recovery from stroke mayoccur. A very important issue
that Peter Turkletaub, one of mycollaborators studies, is there
any way to get the oppositehemisphere language, the former

(01:01:18):
language areas to startfunctioning again, if you have a
stroke as an adult? So we havewhat is called the weak shadow,
the the weak shadow of languagein the right hemisphere.

Stephen Wilson (01:01:35):
I like that term. I like that.

Elissa Newport (01:01:37):
And then yeah, and then this is Kelly Martin
again and then the next step,the next big different step is
to look at childhood stroke andstart looking at when does this
kind of shift over to thehomotopic regions stop? what
happens over the course ofdevelopment that turns into

(01:01:59):
adult aphasia,

Stephen Wilson (01:02:01):
Right! Because it certainly does stop, you
know, and like, you know, as youknow, in my lab, we study people
with aphasia, and I, it'sextremely rare, if ever, that
language moves over to the rightafter an adult stroke. As I'm
sure you know.

Elissa Newport (01:02:16):
Yes. No, I'm, sure. I believe, I don't know
how the data hold up, in youropinion. But there's some
argument that immediately afterthe stroke, you start to see
activation of the homotopicregions in the right, but that
may be because of release ofinhibition, and then the claim
is that it moves back to theleft.

Stephen Wilson (01:02:36):
Yeah, I know. I don't really buy that story. I
mean, I do, I think that's aneat line of work. But I mean, I
guess you're kind of alluding toSaur et. al. 2006. But I kind of
am on board with the analysis ofthat data by Geranmayeh and
colleagues who argued that itwas kind of secondary to task

(01:02:59):
difficulty effects, and, youknow, the challenges that people
have during the task in theimmediate post stroke period.
Yeah, I don't think that there'sa strong evidence for shifts to
the right. But you know, this iskind of something that if there
is, it'd be very exciting. Maybewe'll see that one day.

Elissa Newport (01:03:15):
That's right.
But there is this, I mean, inthe healthy brain, in the adult,
there is... so what Kelly hasdone, she just presented this at
the Neurobiology of LanguageConference last month. If you
look at the adult data fromOlulade et. al. (2020, PNAS),
and you do what, you do a topvoxel approach, you take the

(01:03:38):
adult data, and you say, Okay,if you do a threshold cutoff
analysis, there's clearly moreactivity in the left than the
right. But what if we equalizethe number of voxels that we're
looking at? Where are the mostactive voxels in the right, even
though they're not very active,and they form, that there is a

(01:04:00):
region that's the homotopicregion, to the left, still in
the right hemisphere that'sresponding best to language.
It's still the same pattern ofactivity, it's just not
responding very much. So itdoesn't show up when you do a
threshold cut off.

Stephen Wilson (01:04:20):
Yeah. I mean, I think that that's something that
we always see when we lower, Imean, if you do like pre
surgical language mapping, youalways will routinely play
around with thresholds to like,try and find, you know, where
can I best present this data, togive the surgeon a clearer
picture of what's going on and,you know, most people have, what
did you call it a weak...?

Elissa Newport (01:04:40):
A weak shadow.

Stephen Wilson (01:04:41):
Most people have a weak shadow in the right. I
don't think it's completelysymmetrical you know, I think
that like in the right, like,anterior temporal is much more
prominent, relatively speaking,but by but yeah, I mean, you
know, the same sort of frontal,frontal and temporal regions are
there.

Elissa Newport (01:04:58):
Right. That's right.

Stephen Wilson (01:04:59):
They don't have the same capacity to support
recovery from damage.

Elissa Newport (01:05:03):
No, that's right. But then the question, I
mean, a clinical question ofgreat importance to many people
would be, is there some way thatyou could stimulate it? Does it
have enough ability that it'sjust, it's maybe responding to
weekly, but you could enhancethat? Is there something you
could do that would help peoplewith aphasia who have damaged

(01:05:25):
the left and are not gonnarecover and the left very well?

Stephen Wilson (01:05:28):
Yeah. I mean, I guess many people are exploring
transcranial stimulation methodsto open that up, but I bet I
mean, I guess another thing is,like, you know, pharmaceutical,
like, interventions. I mean, isthere something that you
know.....could we ever have adrug that would re-open the
critical period.

Elissa Newport (01:05:47):
That's right.

Stephen Wilson (01:05:47):
Have you got any ideas about that?

Elissa Newport (01:05:49):
No. So we just had a paper appear in PNAS two
months ago, that's about adultmotor strokes. This is actually
Alex Dromerick's work, it'sDromerick et.al. and so this is
a phase two clinical triallooking at people who had a

(01:06:11):
stroke to the motor regions,either hemisphere. It's not
about lateralization. It's aboutwhether there's a reopening of a
critical period spontaneouslyafter a stroke. And so what they
were doing is following (I'm aco author, but it wasn't
centrally my work) the animalliterature has suggested that

(01:06:34):
immediately after a stroke,there start to be cellular
molecular processes that arelike what you see in early
development, where new synapsesare being spontaneously formed
around the environment and inthe homotopic regions. And the
question asked there was if yougive extra, an extra bolus of

(01:06:56):
physical therapy, does it helpmore if you find this early
window immediately after astroke compared if you do the
same thing later? And the answeris yes, there's a significant
outcome of earlier, during aspecific time window after
stroke, the rehab actually hasmuch bigger effect, a

(01:07:19):
significantly bigger effect. Sostarting outline, when there
might be a critical period afterstroke, so this is called CPAS
is the acronym. It's criticalperiod after stroke study..

Stephen Wilson (01:07:32):
Yeah, that's really interesting. I know,
people have been looking atsimilar concept and aphasia, but
I don't think that they have,like actually done a comparison
between the same amount oftherapy delivered at different
times, they were just kind oflooking at the effect of early
language therapy. And honestly,it's very hard to find that
effect. Because like the, youknow, the amount of natural
recovery is so great that it'shard to see an added effect of

Elissa Newport (01:07:56):
So this study has four groups, it's a phase
this.
two clinical trials has acontrol group and three groups
of administering the same thingat different times and then the
final assessment is 12 monthsafter stroke. And so it's a long
term outcome. And the statisticseven so it's a small effect, the

(01:08:18):
statistics are pretty fancystatistics that look at the
trajectory of recovery. So, partof the advantage is faster
recovery in the earlier groups,and part of it is better
outcome.

Stephen Wilson (01:08:31):
Yeah, well, that's very promising.

Elissa Newport (01:08:31):
Yes. And so again, one would have to do some
kind of enhancement, and that itdoesn't get people back to
normal motor behavior. Some ofthem do. In the paper actually
has this spaghetti curves thatare individual, all the
individual recovery curves areshown and some of the
individuals actually do get backto full ability. But there is

(01:09:00):
a time window. Now the questiois, could you really jack t
at up? Is there some way thatou could improve the outcomes wi
h TMS or with pharmaceuticals orsome combination?

Stephen Wilson (01:09:14):
Yeah. Well, I hope that, that we'll see
something like that in the nextdecades to come. Right. That
would be very cool. Well, thankyou so much for talking to me
today about this work thatyou've done. I really love this
line of work and you know, haveenjoyed hearing about it over
the years. And I, you know,again, today, I learned a bunch

(01:09:34):
more that I hadn't that hadn'treally sunk in before, so this
was a lot of fun.

Elissa Newport (01:09:38):
Thank you. Thank you for having me. Thanks a lot.
Well, you haven't heard aboutsome of it, because it's not
published yet but we're workingas fast as we can.

Stephen Wilson (01:09:45):
Yeah, there's some new stuff. I mean, there's
stuff that I've Yeah, I thinkI've seen you. You know, we've
talked about it over the years.
But yeah, there's new stufftoday that I hadn't heard
before.

Elissa Newport (01:09:55):
Yes.

Stephen Wilson (01:09:56):
Yeah. Very exciting work. Really appreciate
your your time.

Elissa Newport (01:10:00):
Thank you so much for having me. It was fun
to talk with you.

Stephen Wilson (01:10:03):
I'll see you later.

Elissa Newport (01:10:04):
Okay, bye.

Stephen Wilson (01:10:05):
Bye. Okay, well that's it for episode 17. As
always, I've linked the paperswe discussed and Elissa's
website in the show notes and onthe podcast website at
langneurosci.org/podcast. Thanksfor listening and see you next
time.