Rewiring the Brain
Rewiring the Brain: New Frontiers in Aphasia Treatment
By Swarna Kuruganti and Mukul Pandya
When Dr. Swathi Kiran was an undergraduate student in India, she became fascinated by how some brain injuries could cause very specific language deficits. This early interest blossomed into a career dedicated to understanding and treating aphasia – a language disorder that affects about one-third of stroke survivors.
“I was fascinated with trying to figure out how the brain does different things, including sleep and speaking multiple languages,” Dr. Kiran recalls. This curiosity led her to pursue graduate studies at Northwestern University, where she explored the complex relationship between brain damage and language impairment.
Now a professor at Boston University and a leader in the field of aphasia research, Dr. Kiran is pioneering innovative approaches to language recovery that challenge long-held assumptions about how the brain heals after injury. Her work offers new
hope for the millions of people worldwide struggling to regain their ability to communicate after a stroke.
Traditionally, aphasia treatment has followed a “start from scratch” approach, attempting to reteach language skills as if to a child. Dr. Kiran’s research suggests this may not be the most effective strategy. “We had this idea that maybe you don’t want to take an adult brain that has learned so much language — and now had a stroke — and teach them like they’re babies.”
Instead, Dr. Kiran hypothesized that a better approach might be to help patients reconnect and reorganize their existing knowledge of language. This insight led to a new treatment paradigm that focuses on training more complex language skills rather than starting with the basics.
In a groundbreaking study, Dr. Kiran and her colleagues found that training stroke patients on more difficult, complicated words actually led to improvements in simpler words – even without direct practice. This “complexity effect” has since been replicated across various aspects of language, from vocabulary to grammar.
“When we train patients who had a stroke to learn more difficult, complicated information as they were relearning words, they actually learned the easier words without actually receiving the therapy,” Dr. Kiran explains. This counterintuitive approach taps into the brain’s remarkable capacity for plasticity – its ability to rewire and reorganize itself in response to experience and training.
Dr. Kiran’s research has significant implications for stroke survivors’ rehabilitation needs, particularly in addressing their mental and emotional challenges. By focusing on complex language skills, her approach not only improves language function but also potentially boosts confidence and self-esteem. Survivors who can tackle more sophisticated language tasks may feel a greater sense of progress and accomplishment, which can positively impact their emotional well-being.
Further, Dr. Kiran’s work emphasizes the importance of consistent, sustained practice in driving neuroplasticity. “What we have found is that consistent, sustained practice is what improves behavior,” she notes. “And in my own work, looking at brain imaging, trying to understand where in the brain this recovery is happening, that level of sustained practice is what changes the brain.”
The Neuroscience of Language Recovery
Dr. Kiran’s research paper, titled “Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges,” provides a comprehensive overview of the complex neural processes underlying language recovery after stroke. Her research shows that recovery is not a simple matter of reactivating damaged brain areas, but rather involves a dynamic reorganization of entire language networks.
One key insight from this research is the identification of different phases of recovery, each characterized by distinct neurophysiological changes. In the acute phase, immediately following a stroke, a cascade of events occurs in the brain, including inflammation, changes in blood flow, and disruption of neural connections. This is followed by a subacute phase, where the brain begins to repair itself through processes like synaptogenesis (the formation of new neural connections) and neurogenesis (the growth of new neurons).
It’s in the chronic phase, however, where Dr. Kiran’s work has been particularly illuminating. “Although physiological changes occurring during the repair phase have generally subsided as the brain reaches a stable state,” she writes, “mechanisms that facilitate plasticity (i.e., synaptic sprouting) remain at play and are adaptable to environmental experience.” This underscores the brain’s ongoing capacity for change, even years after the initial injury.
Dr. Kiran’s research highlights several factors that influence this long-term neuroplasticity. These include both “organism intrinsic” variables – such as the patient’s age, the size and location of the brain lesion, and the integrity of white matter tracts – and “organism extrinsic” factors, particularly the nature and intensity of language therapy.
Interestingly, Dr. Kiran’s work suggests that the traditional focus on specific brain regions may be too narrow. Instead, she advocates for a network approach to understanding language recovery. This perspective recognizes that language processing involves complex interactions between multiple brain areas, and that effective recovery often involves reorganization of these broader networks.
“It seems reasonable to posit that language recovery engages the same complex network of left and right hemisphere regions,” Dr. Kiran writes, “with specific regions in the network becoming preferentially involved during the course of recovery depending on organism intrinsic and extrinsic factors.”
This network-based understanding of recovery has important implications for treatment. It suggests that therapies should aim not just to reactivate specific damaged areas, but to promote beneficial reorganization of entire language networks. This might involve strengthening connections between spared language areas, recruiting new regions to support language functions, or even enhancing the integration of language networks with other cognitive systems.
For stroke survivors and their care partners, these findings offer important insights. Dr. Kiran’s research challenges the longstanding notion of a fixed “recovery window,” revealing that the potential for improvement extends well beyond the initial months post-stroke. The brain’s remarkable capacity for change, or neuroplasticity, remains active even in chronic stages of aphasia, supporting the case for continued investment in rehabilitation efforts. This insight encourages survivors and their families to persist in their recovery journey, regardless of how much time has passed since the stroke.
Moreover, Dr. Kiran’s work suggests that effective therapy should cast a wider net, targeting not just isolated language skills, but broader language networks and their integration with other cognitive functions. This holistic approach recognizes the complex interplay of various brain regions in language processing and recovery. The research also underscores the critical role of therapy intensity and consistency in driving neuroplasticity and functional improvements, emphasizing the importance of regular, committed practice.
Finally, Dr. Kiran’s findings highlight the significant influence of individual factors, both biological and environmental, on recovery trajectories. This underscores the need for personalized treatment approaches, tailored to each survivor’s unique circumstances and needs. Taken together, these insights offer a more nuanced and optimistic view of aphasia recovery, empowering survivors and their care partners
with knowledge to guide their rehabilitation decisions and maintain hope throughout their journey.
Technology as a Tool: The Constant Therapy App
While the complexity and neuroplasticity approaches offer a promising theoretical framework, delivering intensive, personalized therapy to aphasia patients remains a practical challenge. To address this, Dr. Kiran has embraced technology as an ally in aphasia rehabilitation.
Dr. Kiran worked with colleagues including Veera Anantha, Founder and CEO, Constant Therapy Health, to launch Constant Therapy, a mobile app that delivers customized language and cognitive exercises to patients. The app, which has been used by tens of thousands of people with aphasia, allows for frequent, targeted practice outside of clinical settings.
“The way the app is designed is that as individuals practice therapy, it records the accuracy and response time, which in turn collects millions of data points,” Dr. Kiran notes. This wealth of data not only helps refine individual treatment plans but also provides insights into the recovery process on a broader scale.
The app’s success highlights a crucial factor in aphasia recovery: the intensity and consistency of practice. “For the brain to actually recover and for neuroplasticity to instantiate,” Dr. Kiran explains, “you cannot recover language without a lot of practice.” Digital tools like Constant Therapy make it possible for patients to engage in the kind of repeated, focused practice that drives language recovery.
In clinical trials, the impact of this technology-enabled approach was clear. “If you ask people to come to the clinical therapy, by the time they come, they settle down and they actually do the therapy. They get about 40 minutes of therapy,” Dr. Kiran explains. “But if you ask them to practice at home and then come to the clinic, they get four times that amount of therapy because they’re practicing at home, and then they get that 40 minutes extra.”
In a groundbreaking move for the home health industry, Elara Caring partnered with Constant Therapy Health in April 2024 to implement AI-driven, evidence-based speech-language and cognitive therapy across their extensive network of clinicians and patients.
This increased access to therapy has profound implications for recovery. Dr. Kiran’s research has shown that consistent, sustained practice is what drives both behavioral improvements and changes in brain activation patterns. The app allows patients to practice anywhere, anytime – even while waiting for a bus, as some study participants reported.
For stroke survivors and their care partners, the Constant Therapy app represents a significant leap forward in aphasia rehabilitation, offering benefits that address many of the challenges traditionally associated with therapy. At its core, the app dramatically increases therapy time without the need for additional clinical visits, allowing users to engage in rehabilitative exercises at their own pace and on their own schedule.
By facilitating consistent engagement with therapy between clinical sessions, the app helps maintain momentum in the recovery process, bridging the gaps between in-person treatments. Perhaps most exciting for many users is the potential for faster progress due to more frequent practice, as the app allows for daily engagement with therapeutic exercises, far beyond what is typically possible with traditional therapy schedules.
However, Dr. Kiran also acknowledges some challenges. Access to technology and internet connectivity can be barriers for some patients, potentially exacerbating healthcare disparities. Additionally, while older adults have shown surprising comfort with technology when properly trained, maintaining motivation for consistent practice remains a challenge for some users.
Despite these challenges, the success of Constant Therapy demonstrates the potential of technology to revolutionize aphasia rehabilitation.
Addressing the Gap in Understanding Mental Health Challenges
One of the significant challenges in understanding the mental health needs of stroke survivors, particularly those with aphasia, stems from a historical oversight in clinical research. Dr. Kiran points out that for many years, people with aphasia were routinely excluded from stroke studies and clinical trials.
“All the clinical trials that have been done over the decades have involved motor rehabilitation, upper arm, lower arm, extremity, and they have mostly excluded people with aphasia because they don’t know how to consent people with aphasia and communicate with them,” Dr. Kiran explains. This exclusion has led to a significant gap in our understanding of how aphasia affects overall recovery, including mental health aspects.
To address this gap, researchers like Dr. Aura Kagan have been pioneering a more holistic approach to aphasia treatment and research. Dr. Kagan’s work on the Life Participation Approach to Aphasia (LPAA) emphasizes the importance of considering
the whole person, including their social context, life goals, and emotional well being.
“There has been this general approach, a movement, to understand the life participation of people who have aphasia,” Dr. Kiran notes. “The whole idea is that aphasia [should be considered] in perspective of this bigger context of their life and their finances and their social and the support and a caregiver.”
This shift towards a more comprehensive understanding of aphasia and its impacts is helping to bridge the gap in our knowledge of the mental health challenges faced by stroke survivors with aphasia.
Challenges with AI and Emerging Technologies
While Dr. Kiran is optimistic about the potential of AI and other emerging technologies to assist stroke survivors, she also cautions about some of the challenges these technologies face. One area of concern is the use of AI to complete sentences or predict speech for individuals with aphasia.
“I generally have been cautioning people who have been doing that work,” Dr. Kiran says. She explains that current AI models may not accurately reflect the nuanced struggles of people with aphasia. “I don’t think the models accurately reflect the struggles of people with aphasia.” The risk is that these AI systems might produce inaccurate or inappropriate completions, which could frustrate stroke
survivors and potentially hinder their communication efforts. “As more researchers interact with stroke survivors to understand their speech and implement them into the models, the technology will improve significantly,” Dr. Kiran notes.
However, Dr. Kiran remains hopeful about the future potential of AI in aphasia treatment. She sees great promise in areas such as personalized therapy, where AI could help tailor treatment approaches to individual needs. She also notes the positive impact of technologies like speech-to-text and closed captioning, which have become more widely accepted and used in therapy settings.
Looking to the Future
As populations age and stroke survival rates improve, the need for effective aphasia treatments will only grow. Dr. Kiran’s approach – combining cutting-edge neuroscience with practical, technology-enabled solutions – provides a model for meeting this challenge.
Her work advances our understanding of language recovery and also highlights the importance of addressing the holistic needs of stroke survivors, including their mental and emotional well-being. As research continues and technologies improve, there is hope for increasingly effective, personalized treatments that can help stroke survivors reclaim their voices and rebuild their lives.
“My passion is to understand and improve neuroplasticity after brain damage,” Dr. Kiran says. “I really hope to crack that problem by the time I die.” With her scientific approach and dedication to translating research into practical solutions, she is on her way to rewriting the story of aphasia recovery, one word – and one rewired neural connection – at a time.
About the authors
Swarna Kurungati
Mukul Pandya
Swarna Kuruganti is the Managing Partner at Si-7 LLC, where she shares her thoughtful perspectives on AI’s impact as a speaker and writer, and educator. She leads enterprise AI at US Foods.
Her experiences include leading innovative, emerging technology-enabled solutions, including traditional AI and GenAI, across healthcare and other industries. She has helped define transformed human experiences, while realizing business benefits.
Swarna also contributes to the AI discourse through her writing, with articles in CXOTech, PEX and on LinkedIn, examining business lessons and emerging trends in artificial intelligence.
Her co-authored articles for the American Stroke Association explore the meaningful intersection of technology and recovery, and how AI can help stroke survivors rebuild their sense of self.
She has most recently contributed to industry conversations on AI through speaking engagements at SSON Houston, Tampa Bay Tech and EX3 Labs led XR panel, where she shared insights on implementation approaches while acknowledging the complexities and ongoing learning inherent in this evolving field.
Over her 24+ years as a management consultant, corporate leader and entrepreneur, Swarna has grown a commitment to finding the balance between technological advancement and human-centered outcomes, continually seeking to understand how AI can serve human needs rather than technology for its own sake.
Swarna has a Master’s degree in Information Systems from Baylor University.
Mukul is an Associate Fellow at Oxford University’s Saïd Business School and a consulting editor of Oxford Business Review. Mukul experienced a stroke in 2021 and was a guest author on our column with the American Stroke Association on his experience as a stroke survivor.
He is the founding former editor-in-chief and executive director of Knowledge@Wharton (K@W), the web-based journal of research and business analysis published by the Wharton School of the University of Pennsylvania. He edited and managed K@W for more than 22 years until his retirement in 2020. In 2020-21. He was a Senior Fellow at the research centres Wharton AI for Business and Wharton Customer Analytics.
Mukul has won four awards for investigative journalism and has more than 40 years of experience as a writer and editor. His articles have appeared in The Wall Street Journal, The New York Times, The Economist, Time magazine, The Philadelphia Inquirer and other publications.
He co-authored Lasting Leadership, Knowledge@Wharton on building corporate value and has written, co-authored or edited three other books. In 2020 he edited an award-winning book, Transformation in Times of Crisis, by Nitin Rakesh and Jerry Wind.
Mukul has a master’s degree in economics from the University of Bombay.