At the Brain, Language and Behaviour (BLB) Lab, we are a group of researchers and clinicians united by one common goal: improving the quality of life of brain tumour patients. Based at the University of the West of England, the BLB Lab was born out of Anna Piasecki and Neil Barua’s vision to create a team and space for interdisciplinary and evidence-based translational research.
Translational research focuses on turning scientific discoveries into practical applications that improve human health and wellbeing, aimed at real-world application in (for us) clinical settings. In the context of language and cognitive mapping in awake brain surgery, our team works towards the development of novel tasks and interventions, that clinicians can use to assess and preserve their patients’ language and communication skills.
The starting point: brain tumour treatment
In the UK only, 34 people are diagnosed daily with a primary brain cancer (Cancer Research UK). This number does not include diagnoses of secondary brain cancer or non-cancerous tumours, such as low-grade gliomas, which can adversely affect survivors’ quality of life.
There can be many devastating consequences of living with a brain tumour. For instance, some people may develop language and cognitive impairments, which can lead to difficulties participating in work or social and familial life. Feelings of exclusion and depression are also common among this patient group, as is a reduced life expectancy. These all can lead to an impoverished quality of life.
While treatment for brain tumours is increasingly more effective, the gold standard surgical technique for tumour removal is awake brain surgery (craniotomy, in medical terms), along with adjuvant therapies, such as radio- or chemotherapy.
During an awake craniotomy (see Fig. 1), the patient is woken from sedation to complete several motor, cognitive and language tasks while the neurosurgeon stimulates the brain with direct electrical stimulation. This process guides the mapping of key brain areas for motor, cognitive and language skills, separating those areas from cancerous brain tissue to be cut out. In this way, the tumour can be removed as much as possible, while preserving brain areas that are fundamental to a person’s ability to speak, think, move, and interact with others.
A brief history of language testing in awake craniotomy
Awake language mapping has been performed for nearly a century (Fig. 2 below), starting as early as the late 1920s with Wilder Penfield pioneering cortical stimulation and evolving through the 1980s, when George Ojemann refined language mapping methods.
In the last two decades, neuroimaging techniques (functional magnetic resonance imaging, fMRI, and, diffusor tensor imaging, DTI) and technological advances (virtual and augmented reality) have offered more precise insights into brain structure and function. Similarly, the tasks used for language and cognitive mapping – starting historically with simply counting from 1 to 10 or reciting the months of the year – have also (thankfully!) evolved. How many of us count to ten on a daily basis; unless, of course, you’re an accountant? Nowadays, several language skills are being tested, for example naming pictures of objects and actions, completing sentences, producing sounds, and many more. But there is still a lot to do – and that’s how our work fits in!
Awake brain surgery worldwide and in the UK
You may be wondering, what brain tumour treatment is available where you live in the UK, or rather across the different NHS Trusts? Well, we had the same question and thought it would be important for our work to know the current status quo of language testing practices in this country, especially given the diverse range of practices across the world that have been reported in recent years. For this purpose, we launched a national survey to clinical practitioners working with brain tumour patients in the UK, asking about their approach to language testing, the challenges they face, and if there were any aspects of patient care that would need improvement (click on the picture below to read the paper).
The results highlighted that language testing practices in awake craniotomy vary across the country, with clinicians advocating for more updated and comprehensive tasks to test patients with diverse linguistic skills and languages, such as bilingual patients, sign language users, and people who communicate with impaired speech and language. Equally, clinicians in the UK were calling for a more joined up approach across the Trusts and practices, as well as quicker and better support for patients after their surgery. And these are exactly the things we have started and continue to address, as you can see across the different posts in our blog.
If you ever had an idea you wanted to pursue, make a comment about our work, or if you wanted to join our mission or research team, do get in touch (BLB.Lab@uwe.ac.uk)!
