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Ashaie SA, Hernandez-Pavon JC, Houldin E, Cherney LR. Behavioral, Functional Imaging, and Neurophysiological Outcomes of Transcranial Direct Current Stimulation and Speech-Language Therapy in an Individual with Aphasia. Brain Sci 2024; 14:714. [PMID: 39061454 PMCID: PMC11274865 DOI: 10.3390/brainsci14070714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Speech-language therapy (SLT) is the most effective technique to improve language performance in persons with aphasia. However, residual language impairments remain even after intensive SLT. Recent studies suggest that combining transcranial direct current stimulation (tDCS) with SLT may improve language performance in persons with aphasia. However, our understanding of how tDCS and SLT impact brain and behavioral relation in aphasia is poorly understood. We investigated the impact of tDCS and SLT on a behavioral measure of scripted conversation and on functional connectivity assessed with multiple methods, both resting-state functional magnetic resonance imaging (rs-fMRI) and resting-state electroencephalography (rs-EEG). An individual with aphasia received 15 sessions of 20-min cathodal tDCS to the right angular gyrus concurrent with 40 min of SLT. Performance during scripted conversation was measured three times at baseline, twice immediately post-treatment, and at 4- and 8-weeks post-treatment. rs-fMRI was measured pre-and post-3-weeks of treatment. rs-EEG was measured on treatment days 1, 5, 10, and 15. Results show that both communication performance and left hemisphere functional connectivity may improve after concurrent tDCS and SLT. Results are in line with aphasia models of language recovery that posit a beneficial role of left hemisphere perilesional areas in language recovery.
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Affiliation(s)
- Sameer A. Ashaie
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Evan Houldin
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Leora R. Cherney
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Kaurani P, Moreira de Marchi Apolaro AV, Kunchala K, Maini S, Rges HAF, Isaac A, Lakkimsetti M, Raake M, Nazir Z. Advances in Neurorehabilitation: Strategies and Outcomes for Traumatic Brain Injury Recovery. Cureus 2024; 16:e62242. [PMID: 39006616 PMCID: PMC11244718 DOI: 10.7759/cureus.62242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Traumatic brain injury (TBI) consists of an external physical force that causes brain function impairment or pathology and globally affects 50 million people each year, with a cost of 400 billion US dollars. Clinical presentation of TBI can occur in many forms, and patients usually require prolonged hospital care and lifelong rehabilitation, which leads to an impact on the quality of life. For this narrative review, no particular method was used to extract data. With the aid of health descriptors and Medical Subject Heading (MeSH) terms, a search was thoroughly conducted in databases such as PubMed and Google Scholar. After the application of exclusion and inclusion criteria, a total of 146 articles were effectively used for this review. Results indicate that rehabilitation after TBI happens through neuroplasticity, which combines neural regeneration and functional reorganization. The role of technology, including artificial intelligence, virtual reality, robotics, computer interface, and neuromodulation, is to impact rehabilitation and life quality improvement significantly. Pharmacological intervention, however, did not result in any benefit when compared to standard care and still needs further research. It is possible to conclude that, given the high and diverse degree of disability associated with TBI, rehabilitation interventions should be precocious and tailored according to the individual's needs in order to achieve the best possible results. An interdisciplinary patient-centered care health team and well-oriented family members should be involved in every stage. Lastly, strategies must be adequate, well-planned, and communicated to patients and caregivers to attain higher functional outcomes.
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Affiliation(s)
- Purvi Kaurani
- Neurology, DY Patil University School of Medicine, Navi Mumbai , IND
| | | | - Keerthi Kunchala
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | - Shriya Maini
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Huda A F Rges
- Mental Health, National Authority for Mental Health and Psychosocial Support, Benghazi, LBY
| | - Ashley Isaac
- General Medicine, Isra University Hospital, Hyderabad, PAK
| | | | | | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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Raymer AM, Johnson RK. Effectiveness of Transcranial Direct Current Stimulation as an Adjuvant to Aphasia Treatment Following Stroke: Evidence From Systematic Reviews and Meta-Analyses. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 38306506 DOI: 10.1044/2024_ajslp-23-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
PURPOSE Transcranial direct current stimulation (tDCS) is a neuromodulation tool to amplify neural excitability and enhance outcomes associated with speech-language therapy (SLT). Stimulation currents to the left and right hemispheres vary in applying anodal (excitatory), cathodal (inhibitory), or bihemispheric signals. Several systematic reviews (SRs) and meta-analyses (MAs) have summarized the large literature examining tDCS for aphasia rehabilitation. The purpose of this project was to appraise the quality of SRs and MAs of tDCS for aphasia and examine the weight of the evidence for language outcomes in individuals with aphasia beyond SLT alone. METHOD We searched four databases for SRs/MAs examining effects of tDCS for poststroke aphasia. We identified 16 reviews, with nine that incorporated MA to quantify results. Two reviewers reliably coded articles for methodological rigor using the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews, Version 2). We then summarized findings of the 16 reviews. RESULTS The AMSTAR 2 appraisal criteria suggest that critical weaknesses were noted among all reviews except those by Elsner et al. (2015, 2019). Reviews summarized three to 48 studies, as some included only randomized crossover trials and others included all trial designs. All SRs and one MA reported improvements following tDCS stimulation for general aphasia abilities and measures of repetition and speech fluency. Five recent MAs reported significant naming improvements following tDCS using all stimulation arrays. No tDCS effects were noted for comprehension measures. CONCLUSIONS As the tDCS literature matured, the conclusions of MAs merged with earlier SRs reporting statistically positive benefits over SLT alone. Most consistent results are reported for naming measures, leaving some to question the clinical significance of tDCS effects for functional measures of aphasia recovery. Although the tDCS literature is expansive, important questions remain before the technique can be confidently recommended for clinical practice.
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Affiliation(s)
- Anastasia M Raymer
- School of Speech-Language Pathology, Old Dominion University, Norfolk, VA
| | - Rachel K Johnson
- School of Speech-Language Pathology, Old Dominion University, Norfolk, VA
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Gong C, Hu H, Peng XM, Li H, Xiao L, Liu Z, Zhong YB, Wang MY, Luo Y. Therapeutic effects of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: a systematic review and meta-analysis. Front Hum Neurosci 2023; 17:1177594. [PMID: 37250691 PMCID: PMC10213559 DOI: 10.3389/fnhum.2023.1177594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Background In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive and painless treatment for post-stroke cognitive impairment (PSCI). However, few studies have analyzed the intervention parameters of cognitive function and the effectiveness and safety of rTMS for treating patients with PSCI. Thus, this meta-analysis aimed to analyze the interventional parameters of rTMS and evaluate the safety and effectiveness of rTMS for treating patients with PSCI. Methods According to the PRISMA guidelines, we searched the Web of Science, PubMed, EBSCO, Cochrane Library, PEDro, and Embase to retrieve randomized controlled trials (RCTs) of rTMS for the treatment of patients with PSCI. Studies were screened according to the inclusion and exclusion criteria, and two reviewers independently performed literature screening, data extraction, and quality assessment. RevMan 5.40 software was used for data analysis. Results 12 RCTs involving 497 patients with PSCI met the inclusion criteria. In our analysis, rTMS had a positive therapeutic effect on cognitive rehabilitation in patients with PSCI (P < 0.05). Both high-frequency rTMS and low-frequency rTMS were effective in improving the cognitive function of patients with PSCI by stimulating the dorsolateral prefrontal cortex (DLPFC), but their efficacy was not statistically different (P > 0.05). Conclusions rTMS treatment on the DLPFC can improve cognitive function in patients with PSCI. There is no significant difference in the treatment effect of high-frequency rTMS and low-frequency rTMS in patients with PSCI between high-frequency and low-frequency rTMS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323720, identifier CRD 42022323720.
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Affiliation(s)
- Cheng Gong
- Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hao Hu
- Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xu-Miao Peng
- Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hai Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| | - Li Xiao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| | - Zhen Liu
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| | - Yun Luo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
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Nickels K, Beeson PM, Rising K, Jebahi F, Kielar A. Positive changes to written language following phonological treatment in logopenic variant primary progressive aphasia: Case report. Front Hum Neurosci 2023; 16:1006350. [PMID: 36760227 PMCID: PMC9905434 DOI: 10.3389/fnhum.2022.1006350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/31/2022] [Indexed: 01/26/2023] Open
Abstract
Phonological impairment contributes to deficits in repetition and spoken naming in logopenic variant Primary Progressive Aphasia (lvPPA), but weakened phonology can also affect written language skills. In this experimental case report, we demonstrate phonological text agraphia in a 71-year-old woman in the early stages of lvPPA that undermined her ability to write meaningful, grammatical sentences. We investigated the therapeutic value of a rigorous treatment protocol to strengthen phonological manipulation skills coupled with transcranial direct current stimulation (tDCS). Intervention took place 5 days a week for 2 weeks with active tDCS, followed by a 2-month rest period, and then a second period of phonological treatment with sham tDCS. Over the course of treatment, our participant demonstrated improved phonological transcoding and manipulation skills as well as marked improvement in the proportion of grammatically well-formed, meaningful written narratives. Improvements in spelling and letter selection were also observed. Treatment gains were documented during phonological intervention in both active tDCS and sham treatment phases and were maintained 2 months after the conclusion of intervention. Importantly, improvements were observed in the context of a progressive disorder. These data present compelling evidence regarding the impairment-based approach that targets compromised phonological skills, presenting opportunity for improving functional written communication skills relevant to the everyday lives of individuals with lvPPA.
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Affiliation(s)
- Katlyn Nickels
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States,*Correspondence: Katlyn Nickels,
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States,Department of Neurology, The University of Arizona, Tucson, AZ, United States
| | - Kindle Rising
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
| | - Fatima Jebahi
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
| | - Aneta Kielar
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
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Xie J, Zhou C, Ngaruwenayo G, Wu M, Jiang X, Li X. Dosage consideration for transcranial direct current stimulation in post-stroke dysphagia: A systematic review and network meta-analysis. Front Neurol 2023; 14:1098831. [PMID: 36761340 PMCID: PMC9902951 DOI: 10.3389/fneur.2023.1098831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
Objective This systematic review and network meta-analysis sought to determine the efficacy of different intensities of transcranial direct current stimulation (tDCS) in patients with dysphagia after stroke to improve swallowing function. Methods Randomized-controlled trials (RCTs) of tDCS in post-stroke dysphagia were searched from Pubmed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wanfang database, and Chinese Scientific Journals Database (VIP) from databases' inception to June 22, 2022. Article screening, data extraction, and article quality evaluation were completed by 2 independent researchers. Network meta-analysis was performed using Stata. Results A final total of 20 studies involving 838 stroke patients were included. The included control interventions were sham tDCS and conventional therapy (CT). Network meta-analysis showed that 20 min of 1.2, 1.4, 1.5, 1.6, and 2 mA anodal tDCS and 30 min of 2 mA anodal tDCS significantly improved post-stroke dysphagia compared with CT (all P < 0.05). In addition, 20 min of 1, 1.4, 1.6, and 2 mA anodal tDCS also significantly improved post-stroke dysphagia compared with sham tDCS (all P < 0.05). Our results demonstrated that 20 min of stimulation at 1.4 mA was the optimal parameters for anodal tDCS and exhibited superior efficacy to CT [SMD = 1.08, 95% CI (0.46, 1.69)] and sham tDCS [SMD = 1.45, 95% CI (0.54, 2.36)]. Conclusion Different durations and intensities of anodal tDCS are effective in improving post-stroke dysphagia. However, 20 min of tDCS at 1.4 mA may be the optimal regimen. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022342506.
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Affiliation(s)
- Jianwei Xie
- School of Nursing, China Medical University, Shenyang, China
| | - Chiteng Zhou
- School of Nursing, China Medical University, Shenyang, China
| | | | - Minghui Wu
- General Hospital of Pingmei Shenma Group, Pingdingshan, China
| | - Xiaoyu Jiang
- School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China,*Correspondence: Xiaohan Li ✉
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Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restor Neurol Neurosci 2023; 41:129-191. [PMID: 37980575 PMCID: PMC10741339 DOI: 10.3233/rnn-231344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
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Affiliation(s)
| | - Olga Boukrina
- Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, NJ, USA
| | - Xin Ran Li
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fatima Jebahi
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
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Kashoo FZ, Al-Baradie RS, Alzahrani M, Alanazi A, Manzar MD, Gugnani A, Sidiq M, Shaphe MA, Sirajudeen MS, Ahmad M, Althumayri B, Aljandal A, Almansour A, Alshewaier SA, Chahal A. Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15199. [PMID: 36429924 PMCID: PMC9690138 DOI: 10.3390/ijerph192215199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. METHODS A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. RESULTS Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. CONCLUSIONS Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.
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Affiliation(s)
- Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Raid Saleem Al-Baradie
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzahrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Anchit Gugnani
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Sidiq
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Bader Althumayri
- Department of Physical Therapy, Security Forces Hospital, Riyadh 11564, Saudi Arabia
| | - Abdullah Aljandal
- Department of Physical Therapy and Rehabilitation, Al Fayha Club, Al Majmmah 11952, Saudi Arabia
| | - Ahmed Almansour
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Shady Abdullah Alshewaier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Aksh Chahal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar, Mullana 133207, Haryana, India
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Voegtle A, Reichert C, Hinrichs H, Sweeney-Reed CM. Repetitive Anodal TDCS to the Frontal Cortex Increases the P300 during Working Memory Processing. Brain Sci 2022; 12:1545. [PMID: 36421869 PMCID: PMC9688092 DOI: 10.3390/brainsci12111545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 10/17/2023] Open
Abstract
Transcranial direct current stimulation (TDCS) is a technique with which neuronal activity, and therefore potentially behavior, is modulated by applying weak electrical currents to the scalp. Application of TDCS to enhance working memory (WM) has shown promising but also contradictory results, and little emphasis has been placed on repeated stimulation protocols, in which effects are expected to be increased. We aimed to characterize potential behavioral and electrophysiological changes induced by TDCS during WM training and evaluate whether repetitive anodal TDCS has a greater modulatory impact on the processes underpinning WM than single-session stimulation. We examined the effects of single-session and repetitive anodal TDCS to the dorsolateral prefrontal cortex (DLPFC), targeting the frontal-parietal network, during a WM task in 20 healthy participants. TDCS had no significant impact on behavioral measures, including reaction time and accuracy. Analyzing the electrophysiological response, the P300 amplitude significantly increased following repetitive anodal TDCS, however, positively correlating with task performance. P300 changes were identified over the parietal cortex, which is known to engage with the frontal cortex during WM processing. These findings support the hypothesis that repetitive anodal TDCS modulates electrophysiological processes underlying WM.
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Affiliation(s)
- Angela Voegtle
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Christoph Reichert
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences—CBBS, Otto von Guericke University, 39106 Magdeburg, Germany
| | - Hermann Hinrichs
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences—CBBS, Otto von Guericke University, 39106 Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Catherine M. Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences—CBBS, Otto von Guericke University, 39106 Magdeburg, Germany
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10
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Ashaie SA, Engel S, Cherney LR. Timing of transcranial direct current stimulation (tDCS) combined with speech and language therapy (SLT) for aphasia: study protocol for a randomized controlled trial. Trials 2022; 23:668. [PMID: 35978374 PMCID: PMC9386930 DOI: 10.1186/s13063-022-06627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggest that language recovery in aphasia may be improved by pairing speech-language therapy with transcranial direct current stimulation. However, results from many studies have been inconclusive regarding the impact transcranial direct current stimulation may have on language recovery in individuals with aphasia. An important factor that may impact the efficacy of transcranial direct current stimulation is its timing relative to speech-language therapy. Namely, online transcranial direct current stimulation (paired with speech-language therapy) and offline transcranial direct current stimulation (prior to or following speech-language therapy) may have differential effects on language recovery in post-stroke aphasia. Transcranial direct current stimulation provided immediately before speech-language therapy may prime the language system whereas stimulation provided immediately after speech-language therapy may aid in memory consolidation. The main aim of this study is to investigate the differential effects of offline and online transcranial direct stimulation on language recovery (i.e., conversation) in post-stroke aphasia. METHODS/DESIGN The study is a randomized, parallel-assignment, double-blind treatment study. Participants will be randomized to one of four treatment conditions and will participate in 15 treatment sessions. All groups receive speech-language therapy in the form of computer-based script practice. Three groups will receive transcranial direct current stimulation: prior to speech-language therapy, concurrent with speech-language therapy, or following speech-language therapy. One group will receive sham stimulation (speech-language therapy only). We aim to include 12 participants per group (48 total). We will use fMRI-guided neuronavigation to determine placement of transcranial direct stimulation electrodes on participants' left angular gyrus. Participants will be assessed blindly at baseline, immediately post-treatment, and at 4 weeks and 8 weeks following treatment. The primary outcome measure is change in the rate and accuracy of the trained conversation script from baseline to post-treatment. DISCUSSION Results from this study will aid in determining the optimum timing to combine transcranial direct current stimulation with speech-language therapy to facilitate better language outcomes for individuals with aphasia. In addition, effect sizes derived from this study may also inform larger clinical trials investigating the impact of transcranial direct current stimulation on functional communication in individuals with aphasia. TRIAL REGISTRATION ClinicalTrials.gov NCT03773406. December 12, 2018.
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Affiliation(s)
- Sameer A Ashaie
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.,Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Samantha Engel
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA. .,Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
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Cha TH, Hwang HS. Rehabilitation Interventions Combined with Noninvasive Brain Stimulation on Upper Limb Motor Function in Stroke Patients. Brain Sci 2022; 12:brainsci12080994. [PMID: 35892435 PMCID: PMC9332761 DOI: 10.3390/brainsci12080994] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: This systematic review aimed to focus on the effects of rehabilitation interventions combined with noninvasive brain stimulation on upper limb motor function in stroke patients. (2) Methods: PubMed, MEDLINE, and CINAHL were used for the literature research. Articles were searched using the following terms: "Stroke OR CVA OR cerebrovascular accident" AND "upper limb OR upper extremity" AND "NIBS OR Non-Invasive Brain Stimulation" OR "rTMS" OR "repetitive transcranial magnetic stimulation" OR "tDCS" OR "transcranial direct current stimulation" AND "RCT" OR randomized control trial." In total, 12 studies were included in the final analysis. (3) Results: Analysis using the Physiotherapy Evidence Database scale for qualitative evaluation of the literature rated eight articles as "excellent" and four as "good." Combined rehabilitation interventions included robotic therapy, motor imagery using brain-computer interaction, sensory control, occupational therapy, physiotherapy, task-oriented approach, task-oriented mirror therapy, neuromuscular electrical stimulation, and behavior observation therapy. (4) Conclusions: Although it is difficult to estimate the recovery of upper limb motor function in stroke patients treated with noninvasive brain stimulation alone, a combination of a task-oriented approach, occupational therapy, action observation, wrist robot-assisted rehabilitation, and physical therapy can be effective.
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12
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DeMarco AT, van der Stelt C, Paul S, Dvorak E, Lacey E, Snider S, Turkeltaub PE. Absence of Perilesional Neuroplastic Recruitment in Chronic Poststroke Aphasia. Neurology 2022; 99:e119-e128. [PMID: 35508398 PMCID: PMC9280993 DOI: 10.1212/wnl.0000000000200382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A prominent theory proposes that neuroplastic recruitment of perilesional tissue supports aphasia recovery, especially when language-capable cortex is spared by smaller lesions. This theory has rarely been tested directly and findings have been inconclusive. We tested the perilesional plasticity hypothesis using 2 fMRI tasks in 2 groups of patients with previous aphasia diagnosis. METHODS Two cohorts totaling 82 patients with chronic left-hemisphere stroke with previous aphasia diagnosis and 82 control participants underwent fMRI using either a naming task or a reliable semantic decision task. Individualized perilesional tissue was defined by dilating anatomical lesions and language regions were defined using meta-analyses. Mixed modeling examined differences in activity between groups. Relationships with lesion size and aphasia severity were examined. RESULTS Patients exhibited reduced activity in perilesional language tissue relative to controls in both tasks. Although a few cortical regions exhibited greater activity irrespective of distance from the lesion, or only when distant from the lesion, no regions exhibited increased activity only when near the lesion. Larger lesions were associated with reduced language activity irrespective of distance from the lesion. Using the reliable fMRI task, reduced language activity was related to aphasia severity independent of lesion size. DISCUSSION We found no evidence for neuroplastic recruitment of perilesional tissue in aphasia beyond its typical role in language. Rather, our findings are consistent with alternative hypotheses that changes in left-hemisphere activation during recovery relate to normalization of language network dysfunction and possibly recruitment of alternate cortical processors. These findings clarify left-hemisphere neuroplastic mechanisms supporting language recovery after stroke.
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Affiliation(s)
- Andrew Tesla DeMarco
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Candace van der Stelt
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Sachi Paul
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Elizabeth Dvorak
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Elizabeth Lacey
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Sarah Snider
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Peter E Turkeltaub
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC.
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13
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Gorsler A, Grittner U, Rackoll T, Külzow N. Efficacy of Unilateral and Bilateral Parietal Transcranial Direct Current Stimulation on Right Hemispheric Stroke Patients With Neglect Symptoms: A Proof-of-Principle Study. BRAIN & NEUROREHABILITATION 2022; 15:e19. [PMID: 36743202 PMCID: PMC9833469 DOI: 10.12786/bn.2022.15.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 11/08/2022] Open
Abstract
Different transcranial direct current stimulation (tDCS) protocols have been tested to improve visuospatial neglect (VSN). So far, methodological heterogenity limits reliable conclusions about optimal stimualtion set-up. With this proof-of-principle study behavioral effects of two promising (uni- vs. bilateral) stimulation protocols were directly compared to gain more data for an appropriate tDCS protocol in subacute neglect patients. Notably, each tDCS set-up was combined with an identical sham condition to improve comparability. In a double-blind sham-controlled cross-over study 11 subacute post-stroke neglect patients received 20 minutes or 30 seconds (sham) tDCS (2 mA, 0.8 A/m2) parallel to neglect therapy randomized in unilateral (anode-reference: P4-Fp2 10-20 electroencephalography [EEG] system) and bilateral manner (anode-cathode: P4-P3) and 48h wash-out in-between. Before and immediately after stimulation performance were measured in cancellation task (bell test), and line bisection (deviation error). Significant difference between active and assigned sham condition was found in line bisection but not cancellation task. Particularly, deviation error was reduced after bilateral tDCS (hedges g* = 0.6) compared to bilateral sham, no such advantage were obtained for unilateral stimulation (hedges g* = 0.2). Using a direct comparison approach findings add further evidence that stimulating both hemispheres (bilateral) is superior in alleviating VSN symptoms than unilateral stimulation in subacute neglect.
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Affiliation(s)
- Anna Gorsler
- Kliniken Beelitz GmbH, Clinic for Neurological Rehabilitation, Beelitz-Heilstätten, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Torsten Rackoll
- BIH-QUEST Center for Responsible Research, Charité-Universitätsmedizin, Berlin, Berlin, Germany
| | - Nadine Külzow
- Kliniken Beelitz GmbH, Clinic for Neurological Rehabilitation, Beelitz-Heilstätten, Germany
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14
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Herrmann O, Ficek B, Webster KT, Frangakis C, Spira AP, Tsapkini K. Sleep as a predictor of tDCS and language therapy outcomes. Sleep 2022; 45:zsab275. [PMID: 34875098 PMCID: PMC8919198 DOI: 10.1093/sleep/zsab275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/01/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES To determine whether sleep at baseline (before therapy) predicted improvements in language following either language therapy alone or coupled with transcranial direct current stimulation (tDCS) in individuals with primary progressive aphasia (PPA). METHODS Twenty-three participants with PPA (mean age 68.13 ± 6.21) received written naming/spelling therapy coupled with either anodal tDCS over the left inferior frontal gyrus (IFG) or sham condition in a crossover, sham-controlled, double-blind design (ClinicalTrials.gov identifier: NCT02606422). The outcome measure was percent of letters spelled correctly for trained and untrained words retrieved in a naming/spelling task. Given its particular importance as a sleep parameter in older adults, we calculated sleep efficiency (total sleep time/time in bed x100) based on subjective responses on the Pittsburgh Sleep Quality Index (PSQI). We grouped individuals based on a median split: high versus low sleep efficiency. RESULTS Participants with high sleep efficiency benefited more from written naming/spelling therapy than participants with low sleep efficiency in learning therapy materials (trained words). There was no effect of sleep efficiency in generalization of therapy materials to untrained words. Among participants with high sleep efficiency, those who received tDCS benefitted more from therapy than those who received sham condition. There was no additional benefit from tDCS in participants with low sleep efficiency. CONCLUSION Sleep efficiency modified the effects of language therapy and tDCS on language in participants with PPA. These results suggest sleep is a determinant of neuromodulation effects.Clinical Trial: tDCS Intervention in Primary Progressive Aphasia https://clinicaltrials.gov/ct2/show/NCT02606422.
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Affiliation(s)
- Olivia Herrmann
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kimberly T Webster
- Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Constantine Frangakis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, The Johns Hopkins University, Baltimore, MD, USA
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15
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Harvey DY, Hamilton R. Noninvasive brain stimulation to augment language therapy for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:241-250. [PMID: 35078601 DOI: 10.1016/b978-0-12-823384-9.00012-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral language treatment approaches represent the standard of care for persons with aphasia (PWA), but the benefits of these treatments are variable. Moreover, due to the logistic and financial limitations on the amount of behavioral therapy available to patients, it is often infeasible for PWA to receive behavioral interventions with the level of frequency, intensity, or duration that would provide significant and lasting benefit, underscoring the need for novel, effective treatment approaches. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have emerged as promising neurally-based tools to enhance language abilities for PWA following stroke. This chapter first provides an overview of the methods and physiologic basis motivating the use of NIBS to enhance aphasia recovery followed by a selective review of the growing evidence of its potential as a novel therapeutic tool. Subsequent sections discuss some of the principles that may prove most useful in guiding and optimizing the effects of NIBS on aphasia recovery, focusing on how the functional state of the brain at the time of stimulation interacts with the behavioral aftereffects of neuromodulation. We conclude with a discussion of current challenges and future directions for NIBS in aphasia treatment.
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Affiliation(s)
- Denise Y Harvey
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
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16
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Zettin M, Bondesan C, Nada G, Varini M, Dimitri D. Transcranial Direct-Current Stimulation and Behavioral Training, a Promising Tool for a Tailor-Made Post-stroke Aphasia Rehabilitation: A Review. Front Hum Neurosci 2021; 15:742136. [PMID: 34987366 PMCID: PMC8722401 DOI: 10.3389/fnhum.2021.742136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
Aphasia is an acquired language disorder resulting from damage to portions of the brain which are responsible for language comprehension and formulation. This disorder can involve different levels of language processing with impairments in both oral and written comprehension and production. Over the last years, different rehabilitation and therapeutic interventions have been developed, especially non-invasive brain stimulation (NIBS) techniques. One of the most used NIBS techniques in aphasia rehabilitation is the Transcranial Direct-Current Stimulation (tDCS). It has been proven to be effective in promoting a successful recovery both in the short and the long term after a brain injury. The main strength of tDCS is its feasibility associated with relatively minor side effects, if safely and properly administered. TDCS requires two electrodes, an anode and a cathode, which are generally placed on the scalp. The electrode montage can be either unipolar or bipolar. The main aim of this review is to give an overview of the state of the art of tDCS for the treatment of aphasia. The studies described included patients with different types of language impairments, especially with non-fluent aphasia and in several cases anomia. The effects of tDCS are variable and depend on several factors, such as electrode size and montage, duration of the stimulation, current density and characteristics of the brain tissue underneath the electrodes. Generally, tDCS has led to promising results in rehabilitating patients with acquired aphasia, especially if combined with different language and communication therapies. The selection of the appropriate approach depends on the patients treated and their impaired language function. When used in combination with treatments such as Speech and Language Therapy, Constraint Induced Aphasia Therapy or Intensive Action Treatment, tDCS has generally promoted a better recovery of the impaired functions. In addition to these rehabilitation protocols, Action Observation Therapy, such as IMITAF, appeared to contribute to the reduction of post-stroke anomia. The potential of combining such techniques with tDCS would would therefore be a possibility for further improvement, also providing the clinician with a new action and intervention tool. The association of a tDCS protocol with a dedicated rehabilitation training would favor a generalized long-term improvement of the different components of language.
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Affiliation(s)
- Marina Zettin
- Centro Puzzle, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Giulia Nada
- Department of Psychology, University of Turin, Turin, Italy
| | - Matteo Varini
- Department of Psychology, University of Turin, Turin, Italy
| | - Danilo Dimitri
- Centro Puzzle, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
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17
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Coemans S, Struys E, Vandenborre D, Wilssens I, Engelborghs S, Paquier P, Tsapkini K, Keulen S. A Systematic Review of Transcranial Direct Current Stimulation in Primary Progressive Aphasia: Methodological Considerations. Front Aging Neurosci 2021; 13:710818. [PMID: 34690737 PMCID: PMC8530184 DOI: 10.3389/fnagi.2021.710818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of tDCS approaches has been used to investigate the potential of tDCS to improve language outcomes, or slow down the decay of language competences caused by Primary Progressive Aphasia (PPA). The employed stimulation protocols and study designs in PPA are generally speaking similar to those deployed in post-stroke aphasic populations. These two etiologies of aphasia however differ substantially in their pathophysiology, and for both conditions the optimal stimulation paradigm still needs to be established. A systematic review was done and after applying inclusion and exclusion criteria, 15 articles were analyzed focusing on differences and similarities across studies especially focusing on PPA patient characteristics (age, PPA variant, language background), tDCS stimulation protocols (intensity, frequency, combined therapy, electrode configuration) and study design as recent reviews and group outcomes for individual studies suggest tDCS is an effective tool to improve language outcomes, while methodological approach and patient characteristics are mentioned as moderators that may influence treatment effects. We found that studies of tDCS in PPA have clinical and methodological and heterogeneity regarding patient populations, stimulation protocols and study design. While positive group results are usually found irrespective of these differences, the magnitude, duration and generalization of these outcomes differ when comparing stimulation locations, and when results are stratified according to the clinical variant of PPA. We interpret the results of included studies in light of patient characteristics and methodological decisions. Further, we highlight the role neuroimaging can play in study protocols and interpreting results and make recommendations for future work.
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Affiliation(s)
- Silke Coemans
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
| | - Esli Struys
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Reference Center for Biological Markers of Dementia, BIODEM, Institute Born-Bunge, Universiteit Antwerpen, Antwerp, Belgium
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, Antwerp, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen, Antwerp, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
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18
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de Aguiar V, Rofes A, Wendt H, Ficek BN, Webster K, Tsapkini K. Treating lexical retrieval using letter fluency and tDCS in primary progressive aphasia: a single-case study. APHASIOLOGY 2021; 36:353-379. [PMID: 38765920 PMCID: PMC11101187 DOI: 10.1080/02687038.2021.1881432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/20/2021] [Indexed: 05/22/2024]
Abstract
Background In early stages, individuals with Primary Progressive Aphasia (PPA) report language symptoms while scoring within norm in formal language tests. Early intervention is important due to the progressive nature of the disease. Method We report a single case study of an individual with logopenic variant PPA (lvPPA). We tested whether letter fluency, used as a therapy task, can improve lexical retrieval when combined with tDCS to either the left inferior-frontal gyrus (IFG) or the left inferior parietal lobe (IPL), administered in two separate therapy phases separated by a wash-out period of three months. Outcomes and results We observed increases in number of words retrieved during a letter fluency task in trained and untrained letters, when letter fluency therapy (LeFT) was administered with anodal tDCS. When LeFT was combined with left IFG stimulation, words produced in a letter fluency task were lower frequency and higher age of acquisition after treatment, compared to before treatment and there was also an increase in accuracy and response times in an untrained picture-naming task. Conclusions The results indicate that letter fluency therapy combined anodal tDCS is effective in improving lexical retrieval, particularly when left IFG stimulation was used. Effects generalize beyond the trained task, albeit slowing down of responses in picture naming. This task may provide a useful clinical intervention strategy for patients with mild anomia, who are not challenged enough by traditional naming therapies.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins Medicine
- Center for Language and Cognition Groningen (CLCG), University of Groningen
| | - Adrià Rofes
- Center for Language and Cognition Groningen (CLCG), University of Groningen
- Department of Cognitive Science, Johns Hopkins University
| | - Haley Wendt
- Department of Neurology, Johns Hopkins Medicine
| | | | - Kimberly Webster
- Department of Neurology, Johns Hopkins Medicine
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine
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19
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Romeo Z, Mantini D, Durgoni E, Passarini L, Meneghello F, Zorzi M. Electrophysiological signatures of resting state networks predict cognitive deficits in stroke. Cortex 2021; 138:59-71. [PMID: 33677328 DOI: 10.1016/j.cortex.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/28/2020] [Accepted: 01/29/2021] [Indexed: 01/01/2023]
Abstract
Localized damage to different brain regions can cause specific cognitive deficits. However, stroke lesions can also induce modifications in the functional connectivity of intrinsic brain networks, which could be responsible for the behavioral impairment. Though resting state networks (RSNs) are typically mapped using fMRI, it has been recently shown that they can also be detected from high-density EEG. We build on a state-of-the-art approach to extract RSNs from 64-channels EEG activity in a group of right stroke patients and to identify neural predictors of their cognitive performance. Fourteen RSNs previously found in fMRI and high-density EEG studies on healthy participants were successfully reconstructed from our patients' EEG recordings. We then correlated EEG-RSNs functional connectivity with neuropsychological scores, first considering a wide frequency band (1-80 Hz) and then specific frequency ranges in order to examine the association between each EEG rhythm and the behavioral impairment. We found that visuo-spatial and motor impairments were primarily associated with the dorsal attention network, with contribution dependent on the specific EEG band. These findings are in line with the hypothesis that there is a core system of brain networks involved in specific cognitive domains. Moreover, our results pave the way for low-cost EEG-based monitoring of intrinsic brain networks' functioning in neurological patients to complement clinical-behavioral measures.
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Affiliation(s)
| | - Dante Mantini
- IRCCS San Camillo Hospital, Venice, Italy; Laboratory of Movement Control and Neuroplasticity, Department of Movement Sciences, KU Leuven, Belgium
| | | | | | | | - Marco Zorzi
- IRCCS San Camillo Hospital, Venice, Italy; Department of General Psychology and Padova Neuroscience Center, University of Padova, Italy.
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20
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Gorsler A, Grittner U, Külzow N, Rackoll T. Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m 2: a cross-over pilot study. BMC Res Notes 2021; 14:35. [PMID: 33494832 PMCID: PMC7836170 DOI: 10.1186/s13104-020-05421-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 12/11/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors, higher current densities are probably needed for effective treatment in aged stroke patients. Validation of treatment efficacy requires sham-controlled experiments, but increased current densities might comprise blinding. Therefore, a pilot study was conducted to test sham adequacy when using current density of 0.8 A/m2. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a randomized cross-over design (active/sham stimulation) in 12 early subacute patients with left-sided hemineglect. Stimulation (0.8 A/m2) was performed simultaneous to standard care neglect therapy. Results Odds ratio of correct guessing an atDCS condition compared to wrongly judge an atDCS condition as sham was 10.00 (95%CI 0.65–154.40, p = 0.099). However, given the small sample size and high OR, although likely somewhat overestimated, results require careful interpretation and blinding success in neglect studies with current densities of 0.8 A/m2 should be further confirmed.
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Affiliation(s)
- Anna Gorsler
- Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany. .,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Nadine Külzow
- Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany
| | - Torsten Rackoll
- QUEST Center for Transforming Biomedical Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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21
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Sebastian R, Kim JH, Brenowitz R, Tippett DC, Desmond JE, Celnik PA, Hillis AE. Cerebellar neuromodulation improves naming in post-stroke aphasia. Brain Commun 2020; 2:fcaa179. [PMID: 33241212 PMCID: PMC7677607 DOI: 10.1093/braincomms/fcaa179] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation has been shown to increase the efficiency of language therapy in chronic aphasia; however, to date, an optimal stimulation site has not been identified. We investigated whether neuromodulation of the right cerebellum can improve naming skills in chronic aphasia. Using a randomized, double-blind, sham-controlled, within-subject crossover study design, participants received anodal cerebellar stimulation (n = 12) or cathodal cerebellar stimulation (n = 12) + computerized aphasia therapy then sham + computerized aphasia therapy, or the opposite order. There was no significant effect of treatment (cerebellar stimulation versus sham) for trained naming. However, there was a significant order x treatment interaction, indicating that cerebellar stimulation was more effective than sham immediately post-treatment for participants who received cerebellar stimulation in the first phase. There was a significant effect of treatment (cerebellar stimulation versus sham) for untrained naming immediately post-treatment and the significant improvement in untrained naming was maintained at two months post-treatment. Greater gains in naming (relative to sham) were noted for participants receiving cathodal stimulation for both trained and untrained items. Thus, our study provides evidence that repetitive cerebellar transcranial direct stimulation combined with computerized aphasia treatment can improve picture naming in chronic post-stroke aphasia. These findings suggest that the right cerebellum might be an optimal stimulation site for aphasia rehabilitation and this could be an answer to handle heterogeneous participants who vary in their size and site of left hemisphere lesions.
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Affiliation(s)
- Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Brenowitz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna C Tippett
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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22
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Tscherpel C, Grefkes C. Funktionserholung nach Schlaganfall und die therapeutische Rolle der nicht-invasiven Hirnstimulation. KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1272-9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungIm Bereich der non-invasiven Hirnstimulation stellen die transkranielle Magnetstimulation (engl. transcranial magnetic stimulation, TMS) sowie die transkranielle Gleichstromstimulation (engl. transcranial direct current stimulation, tDCS) bis heute die wichtigsten Techniken zur Modulation kortikaler Erregbarkeit dar. Beide Verfahren induzieren Nacheffekte, welche die Zeit der reinen Stimulation überdauern, und ebnen damit den Weg für ihren therapeutischen Einsatz beim Schlaganfall. In diesem Übersichtsartikel diskutieren wir die aktuelle Datenlage TMS- und tDCS-vermittelter Therapien für die häufigsten schlaganfallbedingten Defizite wie Hemiparese, Aphasie und Neglect. Darüber hinaus adressieren wir mögliche Einschränkungen der gegenwärtigen Ansätze und zeigen Ansatzpunkte auf, um Neuromodulation nach Schlaganfall effektiver zu gestalten und damit das Outcome der Patienten zu verbessern.
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Affiliation(s)
- Caroline Tscherpel
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
| | - Christian Grefkes
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
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23
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Nissim NR, Moberg PJ, Hamilton RH. Efficacy of Noninvasive Brain Stimulation (tDCS or TMS) Paired with Language Therapy in the Treatment of Primary Progressive Aphasia: An Exploratory Meta-Analysis. Brain Sci 2020; 10:E597. [PMID: 32872344 PMCID: PMC7563447 DOI: 10.3390/brainsci10090597] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), paired with behavioral language therapy, have demonstrated the capacity to enhance language abilities in primary progressive aphasia (PPA), a debilitating degenerative neurological syndrome that leads to declines in communication abilities. The aim of this meta-analysis is to systematically evaluate the efficacy of tDCS and TMS in improving language outcomes in PPA, explore the magnitude of effects between stimulation modalities, and examine potential moderators that may influence treatment effects. Standard mean differences for change in performance from baseline to post-stimulation on language-related tasks were evaluated. Six tDCS studies and two repetitive TMS studies met inclusion criteria and provided 22 effects in the analysis. Random effect models revealed a significant, heterogeneous, and moderate effect size for tDCS and TMS in the enhancement of language outcomes. Findings demonstrate that naming ability significantly improves due to brain stimulation, an effect found to be largely driven by tDCS. Future randomized controlled trials are needed to determine long-term effectiveness of noninvasive brain stimulation techniques on language abilities, further delineate the efficacy of tDCS and TMS, and identify optimal parameters to enable the greatest gains for persons with PPA.
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Affiliation(s)
- Nicole R. Nissim
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
| | - Paul J. Moberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy H. Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
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24
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Keator LM, Basilakos A, Rorden C, Elm J, Bonilha L, Fridriksson J. Clinical Implementation of Transcranial Direct Current Stimulation in Aphasia: A Survey of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1376-1388. [PMID: 32437243 PMCID: PMC7893518 DOI: 10.1044/2020_ajslp-19-00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/23/2019] [Accepted: 01/26/2020] [Indexed: 06/11/2023]
Abstract
Purpose The objectives of this study are to (a) identify speech-language pathologists' (SLPs') familiarity with transcranial direct current stimulation (tDCS), (b) quantify what SLPs consider necessary tDCS-related improvement in aphasia severity (i.e., tDCS enhancement; desired improvement above and beyond traditional behavioral therapy) to implement this adjuvant therapy for the clinical management of aphasia, and (c) identify concerns that could potentially hinder the clinical adoption of tDCS. Method A brief (14-question) survey was disseminated via e-mail and social media outlets targeting SLPs working with individuals with aphasia. Results Two hundred twenty-one individuals responded, and 155 valid surveys were analyzed. Seventy-one percent of participants reported familiarity with tDCS prior to taking the survey. Clinicians reported a desired mean enhancement of 22.9% additional points on the Western Aphasia Battery-Revised Aphasia Quotient. Importantly, 94.2% of SLPs reported concerns regarding the implementation of tDCS in clinical settings (i.e., safety, cost, administrative approval, reimbursement and training). Conclusions This is the first study to identify SLPs' perspectives regarding the clinical adoption of tDCS. Results suggest the majority of queried SLPs were familiar with tDCS prior to taking the survey. Although SLPs report a desired improvement of approximately 23% additional points on the Western Aphasia Battery-Revised Aphasia Quotient to consider adopting tDCS into practice, many SLPs reported concerns regarding clinical adoption. Responses from the current survey offer important preliminary evidence to begin bridging the research-to-practice gap as it relates to the clinical implementation of tDCS. Relatedly, these results will inform future clinical trials.
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Affiliation(s)
- Lynsey M. Keator
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Christopher Rorden
- McCausland Center For Brain Imaging, University of South Carolina, Columbia
- Department of Psychology, University of South Carolina, Columbia
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
- McCausland Center For Brain Imaging, University of South Carolina, Columbia
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25
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de Aguiar V, Zhao Y, Faria A, Ficek B, Webster KT, Wendt H, Wang Z, Hillis AE, Onyike CU, Frangakis C, Caffo B, Tsapkini K. Brain volumes as predictors of tDCS effects in primary progressive aphasia. BRAIN AND LANGUAGE 2020; 200:104707. [PMID: 31704518 PMCID: PMC7709910 DOI: 10.1016/j.bandl.2019.104707] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 05/28/2023]
Abstract
The current study aims to determine the brain areas critical for response to anodal transcranial direct current stimulation (tDCS) in PPA. Anodal tDCS and sham were administered over the left inferior frontal gyrus (IFG), combined with written naming/spelling therapy. Thirty people with PPA were included in this study, and assessed immediately, 2 weeks, and 2 months post-therapy. We identified anatomical areas whose volumes significantly predicted the additional tDCS effects. For trained words, the volumes of the left Angular Gyrus and left Posterior Cingulate Cortex predicted the additional tDCS gain. For untrained words, the volumes of the left Middle Frontal Gyrus, left Supramarginal Gyrus, and right Posterior Cingulate Cortex predicted the additional tDCS gain. These findings show that areas involved in language, attention and working memory contribute to the maintenance and generalization of stimulation effects. The findings highlight that tDCS possibly affects areas anatomically or functionally connected to stimulation targets.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center for Language and Cognition Groningen (CLCG), University of Groningen, Netherlands.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Haley Wendt
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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26
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Vila-Nova C, Lucena PH, Lucena R, Armani-Franceschi G, Campbell FQ. Effect of Anodal tDCS on Articulatory Accuracy, Word Production, and Syllable Repetition in Subjects with Aphasia: A Crossover, Double-Blinded, Sham-Controlled Trial. Neurol Ther 2019; 8:411-424. [PMID: 31432434 PMCID: PMC6858895 DOI: 10.1007/s40120-019-00149-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Transcranial direct-current stimulation (tDCS) has been used to modulate and induce changes in brain function and excitability. tDCS is a promising tool for the treatment of aphasia. OBJECTIVE To evaluate whether tDCS improves articulatory accuracy and speech production in patients with aphasia after stroke. METHODS AND RESULTS Twelve right-handed subjects participated in a double-blind, sham-controlled, crossover offline trial. We assessed (1) articulatory accuracy at a naming task, (2) number of words correctly produced, (3) number of syllables repeated correctly, and (4) qualitative assessment of speech. Articulatory accuracy improved when using tDCS over Broca's area in subjects with aphasia post-stroke (p ≤ 0.05). Qualitative improvement in the naming and syllable repetition tasks was observed, but the difference was not statistically significant (respectively, p = 0.15 and p = 0.79). CONCLUSION The current results corroborate the potential of tDCS to be used as an alternative and complementary treatment for individuals with aphasia.
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Affiliation(s)
- Camila Vila-Nova
- União Metropolitana de Educação e Cultura-UNIME, Kroton and University of the State of Bahia, Avenida Luis Tarquínio Pontes, 600, Lauro de Freitas, BA, Brazil.
| | - Pedro H Lucena
- Bahiana School of Medicine and Public Health, Av. Dom João VI, 275, Brotas, Salvador, BA, Brazil
| | - Rita Lucena
- School of Medicine of Bahia, Federal University of Bahia, Av. Luis Viana Filho S/N, Canela, Salvador, BA, Brazil
| | | | - Fernanda Q Campbell
- The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
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27
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de Aguiar V, Zhao Y, Ficek BN, Webster K, Rofes A, Wendt H, Frangakis C, Caffo B, Hillis AE, Rapp B, Tsapkini K. Cognitive and language performance predicts effects of spelling intervention and tDCS in Primary Progressive Aphasia. Cortex 2019; 124:66-84. [PMID: 31838450 DOI: 10.1016/j.cortex.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/16/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Predictors of treatment effects allow individual tailoring of treatment characteristics, thereby saving resources and optimizing outcomes. Electrical stimulation coupled with language intervention has shown promising results in improving language performance in individuals with Primary Progressive Aphasia (PPA). The current study aimed to identify language and cognitive variables associated with response to therapy consisting of language intervention combined with transcranial direct current stimulation (tDCS). Forty individuals with PPA received written naming/spelling intervention combined with anodal tDCS or Sham, using a between-subjects, randomized design, with intervention delivered over a period of 3 weeks. Participants were assessed using a battery of neuropsychological tests before and after each phase. We measured letter accuracy during spelling of trained and untrained words, before, immediately after, 2 weeks, and 2 months after therapy. We used step-wise regression methods to identify variables amongst the neuropsychological measures and experimental factors that were significantly associated with therapy outcomes at each time-point. For trained words, improvement was related to pre-therapy scores, in RAVLT (5 trials sum), pseudoword spelling, object naming, digit span backward, spatial span backward and years post symptom onset. Regarding generalization to untrained words, improvement in spelling was associated with pseudoword spelling, RAVLT proactive interference, RAVLT immediate recall. Generalization effects were larger under tDCS compared to Sham at the 2-month post training measurement. We conclude that, for trained words, patients who improve the most are those who retain for longer language skills such as sublexical spelling processes (phoneme-to-grapheme correspondences) and word retrieval, and other cognitive functions such as executive functions and working memory, and those who have a better learning capacity. Generalization to untrained words occurs through improvement in knowledge of phoneme-to-grapheme correspondences. Furthermore, tDCS enhances the generalizability and duration of therapy effects.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins Medicine; Centre for Language and Cognition Groningen (CLCG), University of Groningen.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health
| | | | - Kimberly Webster
- Department of Neurology, Johns Hopkins Medicine; Department of Otolaryngology, Johns Hopkins Medicine
| | - Adrià Rofes
- Centre for Language and Cognition Groningen (CLCG), University of Groningen; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland; Department of Cognitive Science, Johns Hopkins University
| | - Haley Wendt
- Department of Neurology, Johns Hopkins Medicine
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins Medicine; Department of Cognitive Science, Johns Hopkins University; Department of Physical Medicine & Rehabilitation, Johns Hopkins University
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine; Department of Cognitive Science, Johns Hopkins University
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28
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Abstract
Depression is one of the most disabling conditions in the world. In many cases patients continue to suffer with depressive disorders despite a series of adequate trials of medication and psychotherapy. Neuromodulation treatments offer a qualitatively different modality of treatment that can frequently prove efficacious in these treatment-refractory patients. The field of neuromodulation focuses on the use of electrical/electromagnetic energy, both invasively and noninvasively, to interface with and ultimately alter activity within the human brain for therapeutic purposes. These treatments provide another set of options to offer patients when clinically indicated, and knowledge of their safety, risks and benefits, and appropriate clinical application is essential for modern psychiatrists and other mental health professionals. Although neuromodulation techniques hold tremendous promise, only three such treatments are currently approved by the United States Food and Drug Administration (FDA) for the treatment of major depressive disorder: electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), and repetitive transcranial magnetic stimulation (rTMS). Additionally, numerous other neurostimulation modalities (deep brain stimulation [DBS], magnetic seizure therapy [MST], transcranial electric stimulation [tES], and trigeminal nerve stimulation [TNS]), though currently experimental, show considerable therapeutic promise. Researchers are actively looking for ways to optimize outcomes and clinical benefits by making neuromodulation treatments safer, more efficacious, and more durable.
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Affiliation(s)
| | - Willa Xiong
- Washington University School of Medicine, St. Louis, MO, USA
| | - Charles R Conway
- Washington University School of Medicine, St. Louis, MO, USA. .,John Cochran Division, VA St. Louis Health Care System, St. Louis, MO, USA.
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29
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Bucur M, Papagno C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. Neurosci Biobehav Rev 2019; 102:264-289. [DOI: 10.1016/j.neubiorev.2019.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
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30
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Zhang Y, Song H, Chen Y, Zuo L, Xia X, Zhang X. Thinking on Transcranial Direct Current Stimulation (tDCS) in Reading Interventions: Recommendations for Future Research Directions. Front Hum Neurosci 2019; 13:157. [PMID: 31191272 PMCID: PMC6540963 DOI: 10.3389/fnhum.2019.00157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/25/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Yongjun Zhang
- School of Foreign Languages, Anhui Jianzhu University, Hefei, China.,Centers for Biomedical Engineering, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Hongwen Song
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China
| | - Ying Chen
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China
| | - Lin Zuo
- CAS Key Laboratory of Brain Function and Disease, School of Life Science, University of Science and Technology of China, Hefei, China
| | - Xinzhao Xia
- Centers for Biomedical Engineering, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaochu Zhang
- Centers for Biomedical Engineering, School of Information Science and Technology, University of Science and Technology of China, Hefei, China.,Hefei Medical Research Center on Alcohol Addiction, Anhui Mental Health Center, Hefei, China.,Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
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31
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Fileccia E, Di Stasi V, Poda R, Rizzo G, Stanzani-Maserati M, Oppi F, Avoni P, Capellari S, Liguori R. Effects on cognition of 20-day anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex in patients affected by mild cognitive impairment: a case-control study. Neurol Sci 2019; 40:1865-1872. [PMID: 31062189 DOI: 10.1007/s10072-019-03903-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/13/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a common disorder affecting as much as 15% of the elderly population. Transcranial direct current stimulation (tDCS) is a non-invasive technique of neuromodulation that has proven to influence performance in different cognitive domains. OBJECTIVE/HYPOTHESIS We investigated the effects on cognition of 20-day anodal tDCS in 17 MCI patients compared with 17 matched MCI patients. METHODS Patients underwent neuropsychological evaluation at baseline and then were randomly assigned to the anodal or sham group. The tDCS protocol consisted in 20 min, 5 days per week (up to a total of 20 days), of 2-mA anodal stimulation over the left dorsolateral prefrontal cortex (DLPFC). The location of anodal electrode was chosen in accordance with previous reports which relate anodal stimulation of this site with cognitive enhancement. At the end of the last day of stimulation, a second neuropsychological evaluation was performed. We compared baseline and post-stimulation neuropsychological results in the anodal vs sham group using repeated measures ANOVA as a statistical analysis test. RESULTS At follow-up, patients exposed to anodal stimulation showed improvement in episodic verbal memory (p < 0.001) and figure naming test (p < 0.01), in a general index of cognitive function (Brief Mental Deterioration Battery) (p < 0.0001) and in a mood measurement test (Beck Depression Inventory) (p < 0.01). CONCLUSION Anodal tDCS could be a useful tool to improve cognitive symptoms in MCI although more evidence is needed to understand the exact underlying mechanisms. Confirmation of its potential benefits in MCI would be significant.
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Affiliation(s)
- Enrico Fileccia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | | | - Roberto Poda
- Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Giovanni Rizzo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | | | - Federico Oppi
- Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, Bologna, Italy
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32
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Buchwald A, Calhoun H, Rimikis S, Lowe MS, Wellner R, Edwards DJ. Using tDCS to facilitate motor learning in speech production: The role of timing. Cortex 2018; 111:274-285. [PMID: 30551048 DOI: 10.1016/j.cortex.2018.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/14/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
There exists debate regarding the extent to which transcranial direct current stimulation (tDCS) can affect or enhance human behavior. Here, we examined a previously unexplored domain: speech motor learning. We investigated whether speech motor learning in unimpaired participants can be enhanced using a single-session tDCS experiment, and investigated whether the timing of tDCS relative to a behavioral task affected performance. Participants (N = 80) performed a twenty minute learning task with nonwords containing non-native consonant clusters (e.g., GDEEVOO), and were assigned to groups receiving either sham or active tDCS either immediately before or during the task. Both accuracy and properties of errors were examined throughout the course of the practice task, and then practice was compared to a retention period 30 min later (R1) and two days later (R2). For cluster and whole-(non)word accuracy measures, acquisition was observed for all groups during the practice session. Compared to the beginning of practice, the tDCS-Before group showed significantly greater improvement than both the sham group and the tDCS-During group at R1. An effect was also observed for vowel duration in errors (/gdivu/ → [gədivu]), with the tDCS-Before group showing significant shortening of vowel errors throughout practice. Overall, the findings suggest that tDCS can improve speech motor learning, and that the improvement may be greater when tDCS is applied immediately before practice, warranting further exploration of this new domain for tDCS research.
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Affiliation(s)
- Adam Buchwald
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA.
| | - Holly Calhoun
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Stacey Rimikis
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Mara Steinberg Lowe
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Rebecca Wellner
- New York University, Department of Communicative Sciences and Disorders, New York, NY, USA
| | - Dylan J Edwards
- Burke Medical Research Institute, Edith Cowan University and Weill Cornell Medicine, White Plains, NY, USA; Moss Rehabilitation Research Institute, Philadelphia, PA, USA
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33
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Zandvliet SB, Meskers CGM, Kwakkel G, van Wegen EEH. Short-Term Effects of Cerebellar tDCS on Standing Balance Performance in Patients with Chronic Stroke and Healthy Age-Matched Elderly. THE CEREBELLUM 2018; 17:575-589. [PMID: 29797226 PMCID: PMC6132826 DOI: 10.1007/s12311-018-0939-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transcranial direct current stimulation (tDCS) may serve as an adjunct approach in stroke rehabilitation. The cerebellum could be a target during standing balance training due to its role in motor adaptation. We tested whether cerebellar tDCS can lead to short-term effects on standing balance performance in patients with chronic stroke. Fifteen patients with a chronic stroke were stimulated with anodal stimulation on the contra-lesional cerebellar hemisphere, ipsi-lesional cerebellar hemisphere, or sham stimulation, for 20 min with 1.5 mA in three sessions in randomized order. Ten healthy controls participated in two sessions with cerebellar stimulation ipsi-lateral to their dominant leg or sham stimulation. During stimulation, subjects performed a medio-lateral postural tracking task on a force platform. Standing balance performance was measured directly before and after each training session in several standing positions. Outcomes were center of pressure (CoP) amplitude and its standard deviation, and velocity and its standard deviation and range, subsequently combined into a CoP composite score (comp-score) as a qualitative outcome parameter. In the patient group, a decrease in comp-score in the tandem position was found after contra-lesional tDCS: β = − 0.25, CI = − 0.48 to − 0.03, p = 0.03. No significant differences in demographics and clinical characteristics were found between patients who responded (N = 10) and patients who did not respond (N = 5) to the stimulation. Contra-lesional cerebellar tDCS shows promise for improving standing balance performance. Exploration of optimal timing, dose, and the relation between qualitative parameters and clinical improvements are needed to establish whether tDCS can augment standing balance performance after stroke.
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Affiliation(s)
- Sarah B Zandvliet
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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Malyutina S, Zelenkova V, Buivolova O, Oosterhuis EJ, Zmanovsky N, Feurra M. Modulating the interhemispheric balance in healthy participants with transcranial direct current stimulation: No significant effects on word or sentence processing. BRAIN AND LANGUAGE 2018; 186:60-66. [PMID: 30286319 DOI: 10.1016/j.bandl.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
Patient studies and brain stimulation evidence suggest that language processing can be enhanced by altering the interhemispheric balance: namely, preferentially enhancing left-hemisphere activity while suppressing right-hemisphere activity. To our knowledge, no study has yet compared the effects of such bilateral brain stimulation to both logically necessary control conditions (separate left- and right-hemisphere stimulation). This study did so in a between-group sham-controlled design, applying transcranial direct current stimulation over Broca's area and/or its homologue in 72 healthy participants. The effects were measured not only in a single-word-level task but also in a sentence-level task, rarely tested previously. We did not find either any significant overall effects of stimulation or greater stimulation effects in the bilateral compared to control groups. This null result, obtained in a large sample, contributes to the debate on whether tDCS can modulate language processing in healthy individuals.
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Affiliation(s)
- Svetlana Malyutina
- National Research University Higher School of Economics, Moscow, Russian Federation.
| | - Valeriya Zelenkova
- National Research University Higher School of Economics, Moscow, Russian Federation
| | - Olga Buivolova
- National Research University Higher School of Economics, Moscow, Russian Federation
| | | | - Nikita Zmanovsky
- National Research University Higher School of Economics, Moscow, Russian Federation
| | - Matteo Feurra
- National Research University Higher School of Economics, Moscow, Russian Federation
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The Effect of Anterior Cingulate Cortex Direct Current Stimulation on Speech Monitoring Ability in Individuals with Aphasia: A Randomized, Double-Blinded Study. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/archneurosci.62055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Westwood SJ, Romani C. Null Effects on Working Memory and Verbal Fluency Tasks When Applying Anodal tDCS to the Inferior Frontal Gyrus of Healthy Participants. Front Neurosci 2018; 12:166. [PMID: 29615855 PMCID: PMC5867342 DOI: 10.3389/fnins.2018.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/01/2018] [Indexed: 01/22/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a technique used to modify cognition by modulating underlying cortical excitability via weak electric current applied through the scalp. Although many studies have reported positive effects with tDCS, a number of recent studies highlight that tDCS effects can be small and difficult to reproduce. This is especially the case when attempting to modulate performance using single applications of tDCS in healthy participants. Possible reasons may be that optimal stimulation parameters have yet to be identified, and that individual variation in cortical activity and/or level of ability confound outcomes. To address these points, we carried out a series of experiments in which we attempted to modulate performance in fluency and working memory probe tasks using stimulation parameters which have been associated with positive outcomes: we targeted the left inferior frontal gyrus (LIFG) and compared performance when applying a 1.5 mA anodal current for 25 min and with sham stimulation. There is evidence that LIFG plays a role in these tasks and previous studies have found positive effects of stimulation. We also compared our experimental group (N = 19–20) with a control group receiving no stimulation (n = 24). More importantly, we also considered effects on subgroups subdivided according to memory span as well as to more direct measures of executive function abilities and motivational levels. We found no systematic effect of stimulation. Our findings are in line with a growing body of evidence that tDCS produces unreliable effects. We acknowledge that our findings speak to the conditions we investigated, and that alternative protocols (e.g., multiple sessions, clinical samples, and different stimulation polarities) may be more effective. We encourage further research to explore optimal conditions for tDCS efficacy, given the potential benefits that this technique poses for understanding and enhancing cognition.
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Affiliation(s)
- Samuel J Westwood
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | - Cristina Romani
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
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37
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San-Juan D, Sarmiento CI, González KM, Orenday Barraza JM. Successful Treatment of a Drug-Resistant Epilepsy by Long-term Transcranial Direct Current Stimulation: A Case Report. Front Neurol 2018; 9:65. [PMID: 29479337 PMCID: PMC5811469 DOI: 10.3389/fneur.2018.00065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/25/2018] [Indexed: 12/03/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a reemerged noninvasive cerebral therapy used to treat patients with epilepsy, including focal cortical dysplasia, with controversial results. We present a case of a 28-year-old female with left frontal cortical dysplasia refractory to antiepileptic drugs, characterized by 10–15 daily right tonic hemi-body seizures. The patient received a total of seven sessions of cathodal tDCS (2 mA, 30 min). The first three sessions were applied over three consecutive days, and the remaining four sessions of tDCS were given each at 2-week intervals. At the 1-year follow-up, the patient reported to have a single seizure per month and only mild adverse events.
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Affiliation(s)
- Daniel San-Juan
- Department of Clinical Research, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Carlos Ignacio Sarmiento
- Department of Basic Sciences and Engineering, Autonomous Metropolitan University Campus Iztapalapa, Mexico City, Mexico
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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Transcranial direct current stimulation (tDCS) modulation of picture naming and word reading: A meta-analysis of single session tDCS applied to healthy participants. Neuropsychologia 2017; 104:234-249. [DOI: 10.1016/j.neuropsychologia.2017.07.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/17/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
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Hope TMH, Leff AP, Prejawa S, Bruce R, Haigh Z, Lim L, Ramsden S, Oberhuber M, Ludersdorfer P, Crinion J, Seghier ML, Price CJ. Right hemisphere structural adaptation and changing language skills years after left hemisphere stroke. Brain 2017; 140:1718-1728. [PMID: 28444235 PMCID: PMC5445256 DOI: 10.1093/brain/awx086] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/10/2017] [Indexed: 12/31/2022] Open
Abstract
Stroke survivors with acquired language deficits are commonly thought to reach a ‘plateau’ within a year of stroke onset, after which their residual language skills will remain stable. Nevertheless, there have been reports of patients who appear to recover over years. Here, we analysed longitudinal change in 28 left-hemisphere stroke patients, each more than a year post-stroke when first assessed—testing each patient’s spoken object naming skills and acquiring structural brain scans twice. Some of the patients appeared to improve over time while others declined; both directions of change were associated with, and predictable given, structural adaptation in the intact right hemisphere of the brain. Contrary to the prevailing view that these patients’ language skills are stable, these results imply that real change continues over years. The strongest brain–behaviour associations (the ‘peak clusters’) were in the anterior temporal lobe and the precentral gyrus. Using functional magnetic resonance imaging, we confirmed that both regions are actively involved when neurologically normal control subjects name visually presented objects, but neither appeared to be involved when the same participants used a finger press to make semantic association decisions on the same stimuli. This suggests that these regions serve word-retrieval or articulatory functions in the undamaged brain. We teased these interpretations apart by reference to change in other tasks. Consistent with the claim that the real change is occurring here, change in spoken object naming was correlated with change in two other similar tasks, spoken action naming and written object naming, each of which was independently associated with structural adaptation in similar (overlapping) right hemisphere regions. Change in written object naming, which requires word-retrieval but not articulation, was also significantly more correlated with both (i) change in spoken object naming; and (ii) structural adaptation in the two peak clusters, than was change in another task—auditory word repetition—which requires articulation but not word retrieval. This suggests that the changes in spoken object naming reflected variation at the level of word-retrieval processes. Surprisingly, given their qualitatively similar activation profiles, hypertrophy in the anterior temporal region was associated with improving behaviour, while hypertrophy in the precentral gyrus was associated with declining behaviour. We predict that either or both of these regions might be fruitful targets for neural stimulation studies (suppressing the precentral region and/or enhancing the anterior temporal region), aiming to encourage recovery or arrest decline even years after stroke occurs.
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Affiliation(s)
- Thomas M H Hope
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Alex P Leff
- Institute of Cognitive Neuroscience, University College London, UK.,Department of Brain, Repair and Rehabilitation, Institute of Neurology, University College London, UK
| | - Susan Prejawa
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Rachel Bruce
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Zula Haigh
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Louise Lim
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Sue Ramsden
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Marion Oberhuber
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | | | - Jenny Crinion
- Institute of Cognitive Neuroscience, University College London, UK.,Department of Brain, Repair and Rehabilitation, Institute of Neurology, University College London, UK
| | - Mohamed L Seghier
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Cathy J Price
- Wellcome Trust Centre for Neuroimaging, University College London, UK
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41
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ALHarbi MF, Armijo-Olivo S, Kim ES. Transcranial direct current stimulation (tDCS) to improve naming ability in post-stroke aphasia: A critical review. Behav Brain Res 2017; 332:7-15. [PMID: 28572057 DOI: 10.1016/j.bbr.2017.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation tool that can be used to influence cortical brain activity to induce measurable behavioral changes. Although there is growing evidence that tDCS combined with behavioural language therapy could boost language recovery in patients with post-stroke aphasia, there is great variability in patient characteristics, treatment protocols, and outcome measures in these studies that poses challenges for analyzing the evidence. The purpose of this study is to critically analyze the methodological rigor of the evidence regarding the use of tDCS for post-stroke anomia. METHOD This critical review was conducted by searching four databases (MEDLINE, EMBase, PsycINFO, and CINAHL). Nineteen studies fully met the inclusion criteria. Three critical appraisal tools and Robey and Schultz's (1998) five- phase model for conducting clinical outcome research were adopted to evaluate and analyze the current level of evidence. Methodological issues of the studies were also identified. RESULTS The current level of evidence for using tDCS for anomia is at the pre-efficacy level with emerging evidence at the efficacy level. Lack of proper evaluation of carry-over effects in cross-over studies, lack of or unclear randomization, allocation concealment, and incomplete data handling were the main methodological issues that could threaten the validity of the tDCS for anomia studies. CONCLUSIONS Several methodological issues have been identified in pre-efficacy studies that pose challenges in determining whether tDCS is a beneficial adjunct to behavioral aphasia therapy. Future studies need to improve the quality of the methods used to investigate the effect of tDCS for anomia.
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Affiliation(s)
- Mohammed F ALHarbi
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Speech-language pathology and Audiology, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia.
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Rehabilitation Research Center, University of Alberta, Edmonton, AB, Canada
| | - Esther S Kim
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Dept. of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
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Rofes A, Spena G, Talacchi A, Santini B, Miozzo A, Miceli G. Mapping nouns and finite verbs in left hemisphere tumors: a direct electrical stimulation study. Neurocase 2017; 23:105-113. [PMID: 28347212 DOI: 10.1080/13554794.2017.1307418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurosurgical mapping studies with nouns and finite verbs are scarce and subcortical data are nonexistent. We used a new task that uses finite verbs in six Italian-speaking patients with gliomas in the left language-dominant hemisphere. Language-relevant positive areas were detected only with nouns in four patients, with both tasks yet in distinct cortical areas in one patient, and only with finite verbs in another patient. Positive areas and types of errors varied across participants. Finite verbs provide complementary information to nouns, and permit more accurate mapping of language production when nouns are unaffected by electrical stimulation.
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Affiliation(s)
- Adrià Rofes
- a Global Brain Health Institute , Trinity College Dublin , Dublin , Ireland.,b International Doctorate in Experimental Approaches to Language And the Brain (IDEALAB), Center for Mind/Brain Sciences (CIMEC) , University of Trento , Rovereto , Italy
| | | | - Andrea Talacchi
- d Section of Neurosurgery, Department of Neurosciences , University of Verona , Verona , Italy
| | - Barbara Santini
- d Section of Neurosurgery, Department of Neurosciences , University of Verona , Verona , Italy
| | - Antonio Miozzo
- e Centre for Aging Brain and Neurodegenerative Disorders , University of Brescia , Brescia , Italy
| | - Gabriele Miceli
- b International Doctorate in Experimental Approaches to Language And the Brain (IDEALAB), Center for Mind/Brain Sciences (CIMEC) , University of Trento , Rovereto , Italy.,f Center for Mind/Brain Sciences (CIMeC) , University of Trento , Italy
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43
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Lefebvre S, Liew SL. Anatomical Parameters of tDCS to Modulate the Motor System after Stroke: A Review. Front Neurol 2017; 8:29. [PMID: 28232816 PMCID: PMC5298973 DOI: 10.3389/fneur.2017.00029] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method to modulate the local field potential in neural tissue and consequently, cortical excitability. As tDCS is relatively portable, affordable, and accessible, the applications of tDCS to probe brain-behavior connections have rapidly increased in the last 10 years. One of the most promising applications is the use of tDCS to modulate excitability in the motor cortex after stroke and promote motor recovery. However, the results of clinical studies implementing tDCS to modulate motor excitability have been highly variable, with some studies demonstrating that as many as 50% or more of patients fail to show a response to stimulation. Much effort has therefore been dedicated to understand the sources of variability affecting tDCS efficacy. Possible suspects include the placement of the electrodes, task parameters during stimulation, dosing (current amplitude, duration of stimulation, frequency of stimulation), individual states (e.g., anxiety, motivation, attention), and more. In this review, we first briefly review potential sources of variability specific to stroke motor recovery following tDCS. We then examine how the anatomical variability in tDCS placement [e.g., neural target(s) and montages employed] may alter the neuromodulatory effects that tDCS exerts on the post-stroke motor system.
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Affiliation(s)
- Stephanie Lefebvre
- Neural Plasticity and Neurorehabilitation Laboratory, Chan Division of Occupational Science and Occupational Therapy, Division of Biokinesiology and Physical Therapy, Department of Neurology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Sook-Lei Liew
- Neural Plasticity and Neurorehabilitation Laboratory, Chan Division of Occupational Science and Occupational Therapy, Division of Biokinesiology and Physical Therapy, Department of Neurology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
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Giordano J, Bikson M, Kappenman ES, Clark VP, Coslett HB, Hamblin MR, Hamilton R, Jankord R, Kozumbo WJ, McKinley RA, Nitsche MA, Reilly JP, Richardson J, Wurzman R, Calabrese E. Mechanisms and Effects of Transcranial Direct Current Stimulation. Dose Response 2017; 15:1559325816685467. [PMID: 28210202 PMCID: PMC5302097 DOI: 10.1177/1559325816685467] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The US Air Force Office of Scientific Research convened a meeting of researchers in the fields of neuroscience, psychology, engineering, and medicine to discuss most pressing issues facing ongoing research in the field of transcranial direct current stimulation (tDCS) and related techniques. In this study, we present opinions prepared by participants of the meeting, focusing on the most promising areas of research, immediate and future goals for the field, and the potential for hormesis theory to inform tDCS research. Scientific, medical, and ethical considerations support the ongoing testing of tDCS in healthy and clinical populations, provided best protocols are used to maximize safety. Notwithstanding the need for ongoing research, promising applications include enhancing vigilance/attention in healthy volunteers, which can accelerate training and support learning. Commonly, tDCS is used as an adjunct to training/rehabilitation tasks with the goal of leftward shift in the learning/treatment effect curves. Although trials are encouraging, elucidating the basic mechanisms of tDCS will accelerate validation and adoption. To this end, biomarkers (eg, clinical neuroimaging and findings from animal models) can support hypotheses linking neurobiological mechanisms and behavioral effects. Dosage can be optimized using computational models of current flow and understanding dose–response. Both biomarkers and dosimetry should guide individualized interventions with the goal of reducing variability. Insights from other applied energy domains, including ionizing radiation, transcranial magnetic stimulation, and low-level laser (light) therapy, can be prudently leveraged.
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Affiliation(s)
- James Giordano
- Department of Neurology and Biochemistry, Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - Marom Bikson
- Biomedical Engineering, City College of New York, CUNY, New York, NY, USA
| | - Emily S Kappenman
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - H Branch Coslett
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital and Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Roy Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Jankord
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | | | - R Andrew McKinley
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Center for Working Environmental and Human Factors, Dortmund, Germany
| | | | - Jessica Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Rachel Wurzman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Calabrese
- Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
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Sebastian R, Saxena S, Tsapkini K, Faria AV, Long C, Wright A, Davis C, Tippett DC, Mourdoukoutas AP, Bikson M, Celnik P, Hillis AE. Cerebellar tDCS: A Novel Approach to Augment Language Treatment Post-stroke. Front Hum Neurosci 2017; 10:695. [PMID: 28127284 PMCID: PMC5226957 DOI: 10.3389/fnhum.2016.00695] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/29/2016] [Indexed: 11/13/2022] Open
Abstract
People with post-stroke aphasia may have some degree of chronic deficit for which current rehabilitative treatments are variably effective. Accumulating evidence suggests that transcranial direct current stimulation (tDCS) may be useful for enhancing the effects of behavioral aphasia treatment. However, it remains unclear which brain regions should be stimulated to optimize effects on language recovery. Here, we report on the therapeutic potential of right cerebellar tDCS in augmenting language recovery in SMY, who sustained bilateral MCA infarct resulting in aphasia and anarthria. We investigated the effects of 15 sessions of anodal cerebellar tDCS coupled with spelling therapy using a randomized, double-blind, sham controlled within-subject crossover trial. We also investigated changes in functional connectivity using resting state functional magnetic resonance imaging before and 2 months post-treatment. Both anodal and sham treatments resulted in improved spelling to dictation for trained and untrained words immediately after and 2 months post-treatment. However, there was greater improvement with tDCS than with sham, especially for untrained words. Further, generalization to written picture naming was only noted during tDCS but not with sham. The resting state functional connectivity data indicate that improvement in spelling was accompanied by an increase in cerebro-cerebellar network connectivity. These results highlight the therapeutic potential of right cerebellar tDCS to augment spelling therapy in an individual with large bilateral chronic strokes.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Charltien Long
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Cameron Davis
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | | | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNYNew York, NY, USA
| | - Pablo Celnik
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins UniversityBaltimore, MD, USA
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Westwood SJ, Olson A, Miall RC, Nappo R, Romani C. Limits to tDCS effects in language: Failures to modulate word production in healthy participants with frontal or temporal tDCS. Cortex 2017; 86:64-82. [PMID: 27912107 PMCID: PMC5264390 DOI: 10.1016/j.cortex.2016.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 01/19/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation widely used to modulate cognitive functions. Recent studies, however, suggests that effects are unreliable, small and often non-significant at least when stimulation is applied in a single session to healthy individuals. We examined the effects of frontal and temporal lobe anodal tDCS on naming and reading tasks and considered possible interactions with linguistic activation and selection mechanisms as well as possible interactions with item difficulty and participant individual variability. Across four separate experiments (N, Exp 1A = 18; 1B = 20; 1C = 18; 2 = 17), we failed to find any difference between real and sham stimulation. Moreover, we found no evidence of significant effects limited to particular conditions (i.e., those requiring suppression of semantic interference), to a subset of participants or to longer RTs. Our findings sound a cautionary note on using tDCS as a means to modulate cognitive performance. Consistent effects of tDCS may be difficult to demonstrate in healthy participants in reading and naming tasks, and be limited to cases of pathological neurophysiology and/or to the use of learning paradigms.
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Affiliation(s)
| | - Andrew Olson
- Behavioural Brain Sciences Centre, School of Psychology, University of Birmingham, UK
| | - R Chris Miall
- Behavioural Brain Sciences Centre, School of Psychology, University of Birmingham, UK
| | - Raffaele Nappo
- Aston University, Life & Health Sciences, Birmingham, UK
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48
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Galletta EE, Conner P, Vogel-Eyny A, Marangolo P. Use of tDCS in Aphasia Rehabilitation: A Systematic Review of the Behavioral Interventions Implemented With Noninvasive Brain Stimulation for Language Recovery. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:S854-S867. [PMID: 27997958 DOI: 10.1044/2016_ajslp-15-0133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/12/2016] [Indexed: 06/06/2023]
Abstract
Purpose The purpose of this article is to review the behavioral treatments used in aphasia rehabilitation research that have been combined with transcranial direct current stimulation (tDCS). Although tDCS in aphasia treatment has shown promise, the results have not been conclusive, and their interpretation is further compounded by the heterogeneity of study characteristics. Because implementing a behavioral task during brain stimulation has been shown to be pivotal to the adjuvant effects of tDCS, we analyze the behavioral treatments that have been paired with tDCS. Method A computerized database search (PubMed) was completed to document and review aphasia treatment studies that combine behavioral treatment with noninvasive brain stimulation in the form of tDCS. Two authors reviewed each aphasia tDCS article published between 2008 and 2015 and evaluated (a) the behavioral interventions for aphasia that have been combined with tDCS, and (b) the methodological variables that may have influenced language outcomes in the tDCS aphasia literature. Conclusions A review of the behavioral treatments implemented in tDCS aphasia rehabilitation studies highlights several methodological considerations for future investigations. Impairment-focused and pragmatic treatments have been implemented in tDCS aphasia research studies. No one behavioral approach stands out as the best treatment to combine with tDCS for the promotion of language recovery.
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Affiliation(s)
- Elizabeth E Galletta
- Rusk Rehabilitation, New York University/Langone Medical CenterProgram in Speech-Language-Hearing Sciences, Graduate Center, City University of New York
| | - Peggy Conner
- Program in Speech-Language-Hearing Sciences, Lehman College, City University of New York
| | - Amy Vogel-Eyny
- Program in Speech-Language-Hearing Sciences, Graduate Center, City University of New York
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Napoli, Italy and IRCCS Fondazione Santa Lucia, Roma, Italy
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Darkow R, Martin A, Würtz A, Flöel A, Meinzer M. Transcranial direct current stimulation effects on neural processing in post-stroke aphasia. Hum Brain Mapp 2016; 38:1518-1531. [PMID: 27859982 DOI: 10.1002/hbm.23469] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/14/2016] [Accepted: 11/06/2016] [Indexed: 12/18/2022] Open
Abstract
Non-invasive transcranial direct current stimulation (tDCS) can enhance recovery after stroke. However, fundamental knowledge about how tDCS impacts neural processing in the lesioned human brain is currently lacking. In the present study, it was investigated how tDCS modulates brain function in patients with post-stroke language impairment (aphasia). In a cross-over, randomized trial, patients named pictures of common objects during functional magnetic resonance imaging (fMRI). Concurrently, excitatory (anodal-) or sham-tDCS (1 mA, 20 min, or 30 s, respectively) was administered to the left primary motor cortex, a montage with demonstrated potential to improve aphasic language. By choosing stimuli that could reliable be named by the patients, the authors aimed to derive a pure measure of stimulation effects that was independent of treatment or performance effects and to assess how tDCS interacts with the patients' residual language network. Univariate fMRI data analysis revealed reduced activity in domain-general regions mediating high-level cognitive control during anodal-tDCS. Independent component functional network analysis demonstrated selectively increased language network activity and an inter-correlated shift from higher to lower frequency bands, indicative of increased within-network communication. Compared with healthy controls, anodal-tDCS resulted in overall "normalization" of brain function in the patients. These results demonstrate for the first time how tDCS modulates neural processing in stroke patients. Such information is crucial to assure that behavioral treatments targeting specific neural circuits overlap with regions that are modulated by tDCS, thereby maximizing stimulation effects during therapy. Hum Brain Mapp 38:1518-1531, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert Darkow
- Department of Neurology, NeuroCure Clinical Research Center, and Center of Stroke Research Berlin, Berlin, Charité University Medicine, Berlin, 10117, Germany
| | - Andrew Martin
- The University of Queensland, Centre for Clinical Research, Brisbane Queensland, 4029, Australia
| | - Anna Würtz
- Department of Neurology, NeuroCure Clinical Research Center, and Center of Stroke Research Berlin, Berlin, Charité University Medicine, Berlin, 10117, Germany
| | - Agnes Flöel
- Department of Neurology, NeuroCure Clinical Research Center, and Center of Stroke Research Berlin, Berlin, Charité University Medicine, Berlin, 10117, Germany
| | - Marcus Meinzer
- Department of Neurology, NeuroCure Clinical Research Center, and Center of Stroke Research Berlin, Berlin, Charité University Medicine, Berlin, 10117, Germany.,The University of Queensland, Centre for Clinical Research, Brisbane Queensland, 4029, Australia
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Spielmann K, van de Sandt-Koenderman WME, Heijenbrok-Kal MH, Ribbers GM. Transcranial direct current stimulation in post-stroke sub-acute aphasia: study protocol for a randomized controlled trial. Trials 2016; 17:380. [PMID: 27484456 PMCID: PMC4970230 DOI: 10.1186/s13063-016-1505-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/16/2016] [Indexed: 12/17/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness. Methods We strive to include 58 stroke patients with aphasia, enrolled in an inpatient or outpatient stroke rehabilitation program, in a multicenter, double-blind, randomized controlled trial with two parallel groups and 6 months’ follow-up. Patients will participate in two separate intervention weeks, with a pause of 2 weeks in between, in the context of their regular aphasia rehabilitation program. The two intervention weeks comprise daily 45-minute sessions of word-finding therapy, combined with either anodal tDCS over the left inferior frontal gyrus (1 mA, 20 minutes; experimental condition) or sham-tDCS over the same region (control condition). The primary outcome measure is word-finding. Secondary outcome measures are verbal communication, social participation, quality of life, and cost-effectiveness of the intervention. Discussion Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness. Trial registration Nederlands Trail Register: NTR4364. Registered on 21 February 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1505-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kerstin Spielmann
- Rijndam Rehabilitation Institute, PO Box 23181, 3001, KD, Rotterdam, The Netherlands. .,Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - W Mieke E van de Sandt-Koenderman
- Rijndam Rehabilitation Institute, PO Box 23181, 3001, KD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | | | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, PO Box 23181, 3001, KD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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