Disentangling phonological and articulatory processing: A neuroanatomical study in aphasia.

Phonological and articulatory programming impairments may co-occur in aphasic patients and previous research does not offer a clear-cut picture of their anatomical counterparts. Hickok and Poeppel (2007) put forward a seminal model of speech processes. The ventral stream (mostly bilateral) would be involved in speech recognition and phonological-lexical processing, whereas the dorsal stream (largely lateralized to the left hemisphere) would map phonological representations onto articulatory motor patterns. In this study we analyzed repetition errors for single words and spontaneous speech ratings on the Italian version of the Aachen Aphasia Test. Through a VLSM procedure we aimed at discriminating the neuroanatomical substrates of the phonological and articulatory impairment (and of their normal functional processing). We also estimated functional connectivity networks related to articulation and phonology using seed-to-voxel connectivity analysis with resting state fMRI data. Results indicate that repetition deficit of single words is associated with lesions in a network of left perisylvian areas including the central operculum, the Heschl's gyrus, the angular gyrus, and the supramarginal gyrus (posterior part). Articulatory impairment is associated with lesions in a number of areas in the left dorsal stream, such as the insula (anterior portion), the pars opercularis of the inferior frontal gyrus, the central operculum and the precentral gyrus. On the contrary, phonological impairment is underpinned by lesions of the Heschl's gyrus, and of the posterior portion of the superior temporal and supramarginal gyri. Anatomo-clinical correlative results partly support Hickok and Poeppel's functional model of phonological and articulatory processing.