Predicting Language Outcome and Recovery After Stroke (PLORAS)


Selected Publications


Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, Chollet F, Lin DJ, Grefkes C, Bowman H. Recovery after stroke: the severely impaired are a distinct group. J Neurol Neurosurg Psychiatry. 2022 Apr;93(4):369-378. doi: 10.1136/jnnp-2021-327211. Epub 2021 Dec 22. PMID: 34937750. DOI: 10.1136/jnnp-2021-327211

Geva S, Schneider LM, Khan S, Lorca-Puls DL, Gajardo-Vidal A; PLORAS team; Hope TMH, Green DW, Price CJ. Enhanced left superior parietal activation during successful speech production in patients with left dorsal striatal damage and error-prone neurotypical participants. Cereb Cortex. 2023 Mar 21;33(7):3437-3453. doi: 10.1093/cercor/bhac282. PMID: 35965059; PMCID: PMC10068299. https://doi.org/10.1093/cercor/bhac282

Yamamoto AK, Sanjuán A, Pope R, Parker Jones O, Hope TMH, Prejawa S, Oberhuber M, Mancini L, Ekert JO, Garjardo-Vidal A, Creasey M, Yousry TA, Green DW, Price CJ. The Effect of Right Temporal Lobe Gliomas on Left and Right Hemisphere Neural Processing During Speech Perception and Production Tasks. Front Hum Neurosci. 2022 May 16;16:803163. doi: 10.3389/fnhum.2022.803163. PMID: 35652007; PMCID: PMC9148966. https://doi.org/10.3389/fnhum.2022.803163

RELEASE Collaborators: Brady MC, Ali M, VandenBerg K, Williams LJ, Williams LR, Abo M, Becker F, Bowen A, Brandenburg C, Breitenstein C, Bruehl S, Copland DA, Cranfill TB, Pietro-Bachmann MD, Enderby P, Fillingham J, Lucia Galli F, Gandolfi M, Glize B, Godecke E, Hawkins N, Hilari K, Hinckley J, Horton S, Howard D, Jaecks P, Jefferies E, Jesus LM, Kambanaros M, Kyoung Kang E, Khedr EM, Pak-Hin Kong A, Kukkonen T, Laganaro M, Lambon Ralph MA, Charlotte Laska A, Leemann B, Leff AP, Lima RR, Lorenz A, MacWhinney B, Shisler Marshall R, Mattioli F, Maviş İ, Meinzer M, Nilipour R, Noé E, Paik NJ, Palmer R, Papathanasiou I, Patricio B, Pavão Martins I, Price C, Prizl Jakovac T, Rochon E, Rose ML, Rosso C, Rubi-Fessen I, Ruiter MB, Snell C, Stahl B, Szaflarski JP, Thomas SA, van de Sandt-Koenderman M, van der Meulen I, Visch-Brink E, Worrall L, Harris Wright H. 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. Int J Stroke. 2022 Dec;17(10):1067-1077. doi: 10.1177/17474930221097477. Epub 2022 May 18. PMID: 35422175; PMCID: PMC9679795. 10.1177/17474930221097477


Ekert, J.O., Lorca-Puls, D.L., Gajardo-Vidal, A., Crinion, J.T., Hope, T.M.H., Green, D.W. Price, C.P. 2021. A functional dissociation of the left frontal regions that contribute to single word production tasks. Neuroimage. https://doi.org/10.1016/j.neuroimage.2021.118734.

Ekert, J.O., Gajardo-Vidal, A., Lorca-Puls, D.L., Hope, T.M.H., Dick, F., Crinion, J.T., Green, D.W., Price, C.J. 2021. Dissociating the functions of three left posterior superior temporal regions that contribute to speech perception and production. Neuroimage (in press).

Ekert, J.O., Kirkman, M.A., Seghier, M.L., Green, D.W.,Price, C.J. 2021. A data-based approach for selecting pre- and intra-operative language mapping tasks. Frontiers in Human Neuroscience (in press).

Geva S, Schneider, L.M., Khan, S., Gajardo-Vidal, A., Lorca-Puls, D.L., PLORAS team, Hope, T.M.H., Green, D.W., Price, C.J. 2021. Accurate speech production following cerebellar stroke is associated with enhanced activation in cerebral motor regions. NeuroImage: Clinical. https://doi.org/10.1016/j.nicl.2021.102820.

Lorca-Puls, D., Gajardo-Vidal, A., PLORAS team, Oberhuber, M., Prejawa, S, Hope, TMH, Leff, A.P., Green, D.W., Price, C.J. 2021. Brain regions that support accurate speech production after damage to Broca’s area. Brain Communications. https://doi.org/10.1093/braincomms/fcab230.

Geva, S., Schneider, L., Roberts, S., Khan, S., Gajardo-Vidal A., Lorca-Puls D., PLORAS team, Hope, T.M.H., Green D.W., Price, C.J. 2021. Right cerebral motor areas that support accurate speech production following damage to cerebellar speech areas. NeuroImage: Clinical. https://doi.org/10.1016/j.nicl.2021.102820.

Hope, THM., Nardo, D., Holland, R., Ondobaka, S., Akkad, H., Price, CJ., Leff, A.P., Crinion, J.T. 2021. Lesion site and therapy time predict responses to a therapy for anomia after stroke: a prognostic model development study. Scientific Reports. https://doi.org/10.1101/2021.02.05.429894.

Roberts, S., Bruce, R. M., Lim, L., Woodgate, H., Ledingham, K., Anderson, S., Lorca-Puls, D. L., Gajardo-Vidal, A., Leff, A. P., Hope, T. M. H., Green, D. W., Crinion, J. T. & Price, C. P. 2021. Better long-term speech outcomes in stroke survivors who received early clinical speech and language therapy: What’s driving recovery? Neuropsychological Rehabilitation. https://doi.org/10.1080/09602011.2021.1944883.

Lorca-Puls DL, Gajardo-Vidal A, Green DW, Price CJ. 2021. Reply: Where is the speech production area? Evidence from direct cortical electrical stimulation mapping. Brain. https://doi.org/10.1093/brain/awab177

Geva, S., Schneider, L., Roberts, S., Green D.W., Price, CJ. 2021. The effect of focal damage to the right medial posterior cerebellum on word and sentence comprehension and production. Frontiers Human Neuroscience. https://doi.org/10.3389/fnhum.2021.664650.

Sajid, N., Holmes, E., Hope, T.M., Fountas, Z, Price, C.J. and Friston, K.J. 2021. Simulating lesion-dependent functional recovery mechanisms. Scientific Reports. https://doi.org/10.1038/s41598-021-87005-4.

RELEASE Collaboration. 2021. Predictors of post-stroke aphasia recovery: a systematic review-informed individual participant data (IPD) meta-analysis. Stroke. https://doi.org/10.1161/STROKEAHA.120.031162.

Geva, S., Truneh, T., Seghier, M.L, Hope T.M.H., Leff, A.P., Crinion, J.T., Gajardo-Vidal A., Lorca-Puls D.L., Green D.W., PLORAS team, Price, CJ. 2021. Lesions that do and do not impair digit span: A study of 816 stroke survivors. Brain Communications. https://doi.org/10.1093/braincomms/fcab031.

Bowman H., Bonkhoff , A., Hope TMH, Grefkes C., Price C.J. 2021. Inflated Estimates of Proportional Recovery from Stroke: The Dangers of Mathematical Coupling and Compression to Ceiling. Stroke. https://doi.org/10.1161/STROKEAHA.120.033031.

Gajardo-Vidal A., Lorca-Puls D.L., PLORAS team, Warner H., Bawan, P., Crinion, J.T., Leff, A.P., Hope T.M.H., Geva, S., Seghier, M., Green D.W., Bowman, H., Price, CJ. 2021. Damage to Broca's area does not contribute to long-term speech production outcome after stroke. Brain. https://doi.org/10.1093/brain/awaa460.


Upton, E. & Hope, T.M.H. 2020. Moving beyond the dual stream account of language. Brain. https://doi.org/10.1093/brain/awaa197.

Hope, T.M.H. 2020. Linear regression. “Machine Learning: Methods and Applications to Brain Disorders”, Vieira, S. & Mechelli, A. (eds), Chapter 4. Elsevier. ISBN-13: 9780128157398, 978-0128157398. 

Bonkhoff, A., Hope, T.M.H., Bzdok, D., Guggisberg, A.G., Hawe, R.L., Dukelow, S.P., Rehme, A.K., Fink, G.R., Grefkes, C. & Bowman, H. 2020. Bringing proportional recovery into proportion: Bayesian hierarchical modelling of post-stroke motor performance. Brain. https://doi.org/10.1093/brain/awaa146.

Fleming, V., Brownsett, S., Krason, A., Price, C.J., Crinion, J.T. & Leff, A.P. 2020. Efficacy of spoken word comprehension therapy in patients with chronic aphasia: A cross-over randomised controlled trial with structural imaging. Journal of Neurology, Neurosurgery and Psychiatry. http://dx.doi.org/10.1136/jnnp-2020-324256.

Schevenels, K., Price, C. J., Zink, I., De Smedt, B., & Vandermosten, M. 2020. A review on treatment related brain changes in aphasia. Neurobiology of Language. https://doi.org/10.1162/nol_a_00019.

RELEASE Collaboration. 2020. Communicating simply, but not too simply: Reporting of participants and speech and language interventions for aphasia after stroke. Int J Speech Lang Pathol. https://doi.org/10.1080/17549507.2020.1762000.

Brady, M., Myzoon, A., VandenBerg, K., Williams, L.J. Williams, L.R. and the RELEASE Collaboration. 2020. RELEASE: A protocol for a systematic review based, individual participant data meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia. Aphasiology. https://doi.org/10.1080/17549507.2020.1762000.

Twomey, T., Price, C.J., Waters, D., MacSweeney, M. 2020. The impact of early language exposure on the neural system supporting language in deaf and hearing adults. NeuroImage. https://doi.org/10.1016/j.neuroimage.2019.116411.

Sajid N, Parr T, Gajardo-Vidal A, Price CJ, Friston KJ. 2020. Paradoxical lesions, plasticity and active inference. Brain Commun. https://doi.org/10.1093/braincomms/fcaa164.

Sajid N, Friston KJ, Ekert JO, Price CJ, W Green D. 2020. Neuromodulatory Control and Language Recovery in Bilingual Aphasia: An Active Inference Approach. Behav Sci (Basel). https://doi.org/10.3390/bs10100161.

Sajid, N., Parr, T., Hope, T.M., Price, C.J., Friston, K.J. 2020. Degeneracy and Redundancy in Active Inference. Cerebral Cortex. https://doi.org/10.1093/cercor/bhaa148.

Friston, K.J., Sajid, N., Quiroga-Martinez, D.R., Price, C.J., Holmes, E. 2020. Active listening. Hearing Research. https://doi.org/10.1093/cercor/bhaa148

Friston, K.J., Parr, T., Yufik, Y., Price, C.J., Holmes, E. 2020. Generative models, linguistic communication and active inference. Neuroscience and Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2020.07.005.

Friston KJ, Parr T, Zeidman P, Razi A, Flandin G, Daunizeau J, Hulme OJ, Billig AJ, Litvak V, Price CJ, Moran RJ, Costello A, Pillay D, Lambert C. 2020. Effective immunity and second waves: a dynamic causal modelling study. Wellcome Open Research. https://doi.org/10.12688/wellcomeopenres.16253.2

Friston KJ, Parr T, Zeidman P, Razi A, Flandin G, Daunizeau J, Hulme OJ, Billig AJ, Litvak V, Moran RJ, Price CJ, Lambert C. 2020. Dynamic causal modelling of COVID-19. Wellcome Open Research. https://doi.org/10.12688/wellcomeopenres.15881.2.


Loughnan, R., Lorca-Puls, D. L., Gajardo-Vidal, A., Espejo-Videla, V., Gillebert, C. R., Mantini, D., Price, C.J., Hope, T. M. H. 2019. Generalizing post-stroke prognoses from research data to clinical data. Neuroimage: Clinical. https://doi.org/10.1016/j.nicl.2019.102005.

Evans S, Price CJ, Diedrichsen J, Gutierrez-Sigut E, MacSweeney M. Sign and Speech Share Partially Overlapping Conceptual Representations. 2019. Curr Biol. https://doi.org/10.1016/j.cub.2019.08.075.

Yamamoto AK, Parker Jones O, Hope TMH, Prejawa S, Oberhuber M, Ludersdorfer P, Yousry TA, Green DW, Price CJ. 2019. A special role for the right posterior superior temporal sulcus during speech production. Neuroimage. https://doi.org/10.1016/j.neuroimage.2019.116184.

Yamamoto AK, Magerkurth J, Mancini L, White MJ, Miserocchi A, McEvoy AW, Appleby I, Micallef C, Thornton JS, Price CJ, Weiskopf N, Yousry TA. 2019. Acquisition of sensorimotor fMRI under general anaesthesia: Assessment of feasibility, the BOLD response and clinical utility. Neuroimage Clin. https://doi.org/10.1016/j.nicl.2019.101923.

Zeidman P, Jafarian A, Corbin N, Seghier ML, Razi A, Price CJ, Friston KJ. 2019. A guide to group effective connectivity analysis, part 1: First level analysis with DCM for fMRI. Neuroimage. https://doi.org/10.1016/j.neuroimage.2019.06.031.

Zeidman P, Jafarian A, Seghier ML, Litvak V, Cagnan H, Price CJ, Friston KJ. 2019. A guide to group effective connectivity analysis, part 2: Second level analysis with PEB. Neuroimage. https://doi.org/10.1016/j.neuroimage.2019.06.032.

Ludersdorfer P, Price CJ, Kawabata Duncan KJ, DeDuck K, Neufeld NH, Seghier ML. 2019. Dissociating the functions of superior and inferior parts of the left ventral occipito-temporal cortex during visual word and object processing. Neuroimage. https://doi.org/10.1016/j.neuroimage.2019.06.003.


Hope, T.M.H., Friston, K.J., Price, C.J., Leff, A., Rotstein, P.  & Bowman, H. 2018. Recovery after stroke: not so proportional after all? Brain, 142 (1), 15-22.

Gajardo-Vidal, A., Lorca-Puls, D.L., Hope, T.M.H., Parker Jones, O., Seghier, M.L., Oberhuber, M., Prejawa, S., Crinion, J., Leff, A.P., Green, D.W. & Price, C.J. 2018. How right hemisphere damage after stroke can impair speech comprehension. Brain, 141 (12), 3389-3404. 

Hope, T.M.H., Leff, A.P. & Price, C.J. 2018. Predicting language outcomes after stroke: Is structural disconnection a useful predictor? Neuroimage: Clinical, 19, 22-29.

Seghier, M.L. & Price, C.J. 2018. Interpreting and utilizing inter-subject variability in brain function. Trends in Cognitive Sciences22, 517-530.

Lorca-Puls, D., Gajardo-Vidal, A., White, J., Seghier, M., Leff, A., Green, D., Crinion, J., Ludersdorfer, P., Hope, T., Bowman, H. & Price, C.J. 2018. The impact of sample size on the reproducibility of voxel-based lesion-deficit mappings. Neuropsychologia, 115, 101-111.

Gajardo-Vidal, A., Lorca-Puls, D.L., Crinion, J.T., White, J., Seghier, M.L., Leff, A.P., Hope, T.M.H., Ludersdorfer, P., Green, D.W., Bowman, H. & Price, CJ.  2018. How distributed processing produces false negatives in voxel-based lesion-deficit analyses. Neuropsychologia115, 124-133.

Aguilar, O.M., Kerry, S.J., Ong, Y-H, Callaghan, M.F., Crinion, J., Woodhead, Z.V.J., Price, C.J., Leff, A.P. & Hope, T.M.H. 2018. Lesion site dependent responses to therapy after aphasic stroke. Journal of Neurology, Neurosurgery, and Psychiatry89 (12), 1352-1354.

Price, C.J. 2018. The evolution of cognitive models: From neuropsychology to Neuroimaging and back. Cortex, 107, 37-49.


Nardo, D., Holland, R., Leff, A.P., Price, C.J. & Crinion, J.T. 2017. Less is more: Neural mechanisms underlying anomia treatment in chronic aphasia patients.  Brain, 140, 3039-3054.

Achilles, E.I.S., Weiss, P.H., Fink, G.R., Binder, E., Price, C.J. & Hope, T.M.H. 2017. Using multi-level Bayesian lesion-symptom mapping to probe the body-part-specificity of gesture imitation skills.  Neuroimage, 161, 94-103.

Woodhead, Z.V.J., Crinion, J., Penny, W., Teki, S., Price, C.J. & Leff, A.P. 2017. Auditory training changes temporal lobe connectivity in 'Wernicke’s aphasia': a randomized trial. Journal of Neurology, Neurosurgery, and Psychiatry, 88, 586-594.

Hope, T.M.H., Leff, A.P., Prejawa, S., Bruce, R., Haigh, Z., Lim, L., Ramsden, S., Oberhuber, M., Ludersdorfer, P., Crinion, J., Seghier, M.L. & Price C.J. 2017. Right hemisphere structural adaptation and changing language skills years after left hemisphere stroke. Brain, 140 (6), 1718-1728.

Lorca-Puls, D.L., Gajardo-Vidal, A., Seghier, M.L., Leff, A.P., Sethi, V., Prejawa, S., Hope, T.M.H., Devlin, J.T. and Price, C.J. 2017. Using transcranial magnetic stimulation of the undamaged brain to identify lesion sites that predict language outcome after stroke. Brain140 (6), 1729-1742.

Price, C.J., Hope, T.M., Seghier, M.L. 2017. Ten problems and solutions when predicting individual outcome from lesion site after stroke. Neuroimage, 145 (B), 200-208.


Hope, T.M., Seghier, M.L., Prejawa, S., Leff, A.P., Price, C.J. 2016. Distinguishing the effect of lesion load from tract disconnection in the arcuate and uncinate fasciculi. Neuroimage, 125, 1169-1173.

Seghier, M.L., Patel, E., Prejawa, S., Ramsden, S., Selmer, A., Lim, L., Browne, R., Rae, J., Haigh, Z., Ezekiel, D., Hope, T.M., Leff, A.P., Price, C.J. 2016. The PLORAS Database: A data repository for Predicting Language Outcome and Recovery After Stroke. Neuroimage124 (B), 1208-1212.


Hope, T.M., Parker Jones, O., Grogan, A., Crinion, J., Rae, J., Ruffle, L., Leff, A.P., Seghier, M.L., Price, C.J., Green, D.W. 2015. Comparing language outcomes in monolingual and bilingual stroke patients. Brain, 1-14.


Seghier, M.L., Ramsden, S., Lim, L., Leff, A. P. and Price, C. 2014. Gradual Lesion Expansion and Brain Shrinkage Years After Stroke. Stroke45, 877-879.


Hope, T., Seghier M., Leff, A. and Price, C. 2013. Predicting outcome and recovery after stroke with lesions extracted from MRI images. NeuroImage: Clinical, (1), 424-433.


  • This paper presents a method that combines the influence of stroke, time post stroke and demographic information in a large group of stroke patients to predict the likely course of recovery over time in new patients.


Ambridge, L., Leff, A., Crinion, J., and Price, C. October 2010. Predicting language outcome and recovery after stroke. Royal College of Speech & Language Therapists Bulletin, 12-15. 


  • This article was written for the Royal College of Speech & Language Therapists Bulletin.  
  • It gives an overview of the reasons for the project, the methods used, and some findings.

Price, C., Seghier, M., and Leff, A. 2010. Predicting language outcome and recovery after stroke: the PLORAS system. Nature Reviews Neurology6, 202-210.


  • This paper presents a new approach for predicting language outcome and recovery after stroke.
  • It compares the practicality of two different possibilities.
  • The initial perspective was to understand the neural circuits that support language (the wiring in the brain) but this is a complicated endeavour.
  • The new method is more pragmatic and makes predictions on the basis of the recovery of previous patients with the same type of stroke.
  • This method requires a database that records the speech and language skills of a large group of patients who have a range of stroke sites. 
  • It also requires a very precise and accurate way of measuring the location and extent of the lesion in three dimensional high definition space.

Price, C., Crinion, J., Leff, A., Richardson, F., Schofield, T., Prejawa, S., Ramsden, S., Gazarian, K., Lawrence, M., Ambridge, L., Andric, M., Small, S. and Seghier, M. 2010. Lesion sites that predict the ability to gesture how an object is used. Archives Italiennes de Biologie, 148(3), 243-258.


  • This study combined three methodologies to identify the brain regions where damage impairs the ability to gesture how an object is moved while preserving the ability to recognise the object and move the hands.
  • The results demonstrate that the mapping between lesion site and symptoms is not one-to-one, because different lesion sites can cause the same symptom and different symptoms can result from the same lesion site, depending on the degree of damage to other areas.  For example, the effect of losing the use of your index finger depends on whether or not the other fingers can still be used.
  • The take home message is that predicting outcome from lesion sites requires a consideration of the combination of regions that are damaged.


Seghier, M., Ramlackhansingh, A., Crinion, J., Leff, A. and Price, C. 2008. Lesion identification using unified segmentation-normalisation models and fuzzy clustering. Neuroimage, 41, 1253.


  • This paper introduces a new procedure for identifying stroke sites from MRI scan images of the brain. 
  • This procedure is able to detect stroke sites with different sizes, locations, and textures. 
  • The approach can help to explain how different stroke sites affect behaviour of a stroke survivor (such as language skills) 
  • The method should help to find the total volume of the stroke site or to find the exact boundaries of the stroke.  This could be useful for surgical purposes or diagnosing problems.


Price, C. and Friston, K. 2002. Degeneracy and cognitive anatomyTrends in Cognitive Sciences, 6(10), 416-421.  Abstract.  Contact Us for the full text.


  • This paper was fundamental in shaping our approach to understanding the relationship between lesion site and cognitive deficit.
  • The core idea is that the brain has different ways of doing the same thing. This is similar to knowing that it is possible to write using either the left or the right hand. If we lose the left hand, we become more reliant on the right hand, and if we lose the right hand, we can use our left hand (with practice).
  • These alternative ways of doing the same thing are available in the healthy brain (or body) but there are a limited number of options.  For example, if you lose the use of both your right and left hand then you may need to learn to write with a pen in your mouth or your toes.  There are not an infinite number of viable options and the alternative possibilities may be laborious. 
  • Recovery therefore depends on the availability of efficient options. 
  • In terms of methodology, the paper proposes a way to understand and delineate the sets of brain regions that can support a particular function.  
  • However, as described in more recent papers (see above), we now think that it ismore effective to predict outcome and recovery using a pragmatic database approach as opposed to understanding all the underlying theory. 
  • Likewise, although it is important that you know that your car won't start if the engine's battery is dead, a driver does not need to know how the battery or the engine work.