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Alemanno F, Fedeli D, Monti A, Houdayer E, Della Rosa PA, Zangrillo F, Emedoli D, Pelagallo E, Corbo M, Iannaccone S, Abutalebi J. Increased interhemispheric functional connectivity after right anodal tDCS in chronic non-fluent aphasia: preliminary findings. Front Neurosci 2024; 18:1346095. [PMID: 38406588 PMCID: PMC10884287 DOI: 10.3389/fnins.2024.1346095] [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: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical excitability. In post-stroke aphasia, the role of the right hemisphere in language recovery remains debated. In this preliminary study, we aimed to investigate the efficacy of excitatory tDCS on the right hemisphere in chronic aphasic patients. Methods We applied anodal tDCS to the right homologous region of Broca's area in four chronic aphasic patients while performing a one-month naming rehabilitation treatment. Longitudinal data on language assessment and naming performance were collected. Resting-state fMRI images were acquired before and after treatment to measure changes in functional connectivity. Results Results showed enhanced positive functional connectivity of the right Broca homologous with the left middle frontal and middle temporal gyri. Every patient showed improvements in language functions, but no major changes in naming performance. Conclusion These preliminary findings suggest that tDCS applied over the unaffected hemisphere may result in longitudinal inter-hemispheric functional neuroplastic changes that could specifically improve language recovery and could potentially be included in therapeutic neurorehabilitative plans.
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Affiliation(s)
- Federica Alemanno
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Fedeli
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Elise Houdayer
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Federica Zangrillo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Emedoli
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pelagallo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Sandro Iannaccone
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jubin Abutalebi
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Picciuca C, Assogna M, Esposito R, D’Acunto A, Ferraresi M, Picazio S, Borghi I, Martino Cinnera A, Bonnì S, Chiurazzi P, Koch G. Transcranial direct current stimulation combined with speech therapy in Fragile X syndrome patients: a pilot study. Front Neurol 2023; 14:1268165. [PMID: 38116107 PMCID: PMC10729003 DOI: 10.3389/fneur.2023.1268165] [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: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 12/21/2023] Open
Abstract
Background Fragile X syndrome (FXS) is the leading cause of genetic intellectual disability. Among the neurobehavioral dysfunctions in FXS individuals, language development and literacy are compromised. Recent evidence hypothesized that the disruption of excitatory glutamatergic and GABAergic inhibitory neurotransmission balance might be responsible for impairment in cognitive function. In this study, we evaluated for the first time, the safety, tolerability, and efficacy of anodal prefrontal transcranial direct current stimulation (tDCS) combined with standard speech therapy to enhance language function in FXS patients. Methods In total, 16 adult FXS patients were enrolled. Participants underwent 45 min of anodic tDCS combined with speech therapy for 5 weeks (3 times per week). Language function was evaluated using the Test for Reception of Grammar-Version 2 (TROG-2) and subtests of the Italian Language Examination (Esame del Linguaggio - II, EDL-II). Right and left dorsolateral prefrontal cortex transcranial magnetic stimulation and concurrent electroencephalography (TMS-EEG) recordings were collected at baseline and after the treatment to evaluate cortical reactivity and connectivity changes. Results After 5 weeks of combined therapy, we observed a significant improvement in the writing (7.5%), reading (20.3%), repetition (13.3%), and TROG-2 (10.2%) tests. Parallelly with clinical change, TMS-EEG results showed a significant difference in TMS-evoked potential amplitude over the left frontal cortex after treatment (-0.73 ± 0.87 μV) compared to baseline (0.18 ± 0.84 μV). Conclusion Our study provides novel evidence that left anodal prefrontal tDCS combined with standard speech therapy could be effective in enhancing language function in FXS patients, mainly by inducing a rebalance of the dysfunctional prefrontal cortical excitability.
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Affiliation(s)
- Chiara Picciuca
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Martina Assogna
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Romina Esposito
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alessia D’Acunto
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Matteo Ferraresi
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Silvia Picazio
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Ilaria Borghi
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alex Martino Cinnera
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Sonia Bonnì
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Pietro Chiurazzi
- Sezione di Medicina genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Genetica Medica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giacomo Koch
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Williams EER, Sghirripa S, Rogasch NC, Hordacre B, Attrill S. Non-invasive brain stimulation in the treatment of post-stroke aphasia: a scoping review. Disabil Rehabil 2023:1-22. [PMID: 37828899 DOI: 10.1080/09638288.2023.2259299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Aphasia is an acquired language impairment that commonly results from stroke. Non-invasive brain stimulation (NIBS) might accelerate aphasia recovery trajectories and has seen mounting popularity in recent aphasia rehabilitation research. The present review aimed to: (1) summarise all existing literature on NIBS as a post-stroke aphasia treatment; and (2) provide recommendations for future NIBS-aphasia research. MATERIALS AND METHODS Databases for published and grey literature were searched using scoping review methodology. 278 journal articles, conference abstracts/posters, and books, and 38 items of grey literature, were included for analysis. RESULTS Quantitative analysis revealed that ipsilesional anodal transcranial direct current stimulation and contralesional 1-Hz repetitive transcranial magnetic stimulation were the most widely used forms of NIBS, while qualitative analysis identified four key themes including: the roles of the hemispheres in aphasia recovery and their relationship with NIBS; heterogeneity of individuals but homogeneity of subpopulations; individualisation of stimulation parameters; and much remains under-explored in the NIBS-aphasia literature. CONCLUSIONS Taken together, these results highlighted systemic challenges across the field such as small sample sizes, inter-individual variability, lack of protocol optimisation/standardisation, and inadequate focus on aphasiology. Four key recommendations are outlined herein to guide future research and refine NIBS methods for post-stroke aphasia treatment.
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Affiliation(s)
- Ellen E R Williams
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Sabrina Sghirripa
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Nigel C Rogasch
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
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Zhang X, Talifu Z, Li J, Li X, Yu F. Melodic intonation therapy for non-fluent aphasia after stroke: A clinical pilot study on behavioral and DTI findings. iScience 2023; 26:107453. [PMID: 37744405 PMCID: PMC10517365 DOI: 10.1016/j.isci.2023.107453] [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: 04/03/2023] [Revised: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Music-based melodic intonation therapy (MIT) has shown promise as a treatment for non-fluent aphasia after stroke. This trial compared the efficacy of music-based MIT and speech therapy (ST) in aphasia, focusing on arcuate fasciculus connectivity in brain structural and language ability scores. A total of 62 patients were enrolled, of whom 40 completed the trial. The experimental group received MIT for 30 min/d, five days per week for four weeks, while the control group received ST with the same dose. The BDAE and fMRI-DTI were performed at T0 and T1. The music-based MIT group demonstrated better language levels. DTI showed that FA, FN, and path length of the MIT group in the right hemisphere were significantly increased. Music-based MIT had positive effects on reorganization and activation of arcuate fasciculus in aphasia after stroke. This research is funded by NSFC No. T2341003 and No.2020CZ-10. Clinical Trials ChiCTR2000037871. Ethics approval number: 2020-013-1.
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Affiliation(s)
- Xiaoying Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China
- Department of Music Artificial Intelligence and Music Information Technology, Central Conservatory of Music, Beijing 100038, China
- Institute of Advanced Science and Technology, Xi’an Jiaotong University, Xi’an 710079, Shanxi, China
- Music Therapy Center, China Rehabilitation Research Center, Beijing 100068, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing 100068, China
| | - Zuliyaer Talifu
- School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China
- Music Therapy Center, China Rehabilitation Research Center, Beijing 100068, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing 100068, China
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China
- Music Therapy Center, China Rehabilitation Research Center, Beijing 100068, China
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing 100068, China
| | - Xiaobing Li
- Department of Music Artificial Intelligence and Music Information Technology, Central Conservatory of Music, Beijing 100038, China
- Institute of Advanced Science and Technology, Xi’an Jiaotong University, Xi’an 710079, Shanxi, China
| | - Feng Yu
- Department of Music Artificial Intelligence and Music Information Technology, Central Conservatory of Music, Beijing 100038, China
- Institute of Advanced Science and Technology, Xi’an Jiaotong University, Xi’an 710079, Shanxi, China
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Yan Z, He X, Cheng M, Fan X, Wei D, Xu S, Li C, Li X, Xing H, Jia J. Clinical study of melodic intonation therapy combined with transcranial direct current stimulation for post-stroke aphasia: a single-blind, randomized controlled trial. Front Neurosci 2023; 17:1088218. [PMID: 37397451 PMCID: PMC10308281 DOI: 10.3389/fnins.2023.1088218] [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: 11/03/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background Globally, more than 10 million new stroke cases occur annually, of which aphasia accounts for about one-third. Aphasia has become an independent predictor of functional dependence and death for the stroke population. The closed-loop rehabilitation of combining behavioral therapy with central nerve stimulation seems to be the research trend of post-stroke aphasia (PSA) due to its advantages in improving linguistic deficits. Objective To verify the clinical efficacy of a closed-loop rehabilitation program combining melodic intonation therapy (MIT) with transcranial direct current stimulation (tDCS) for PSA. Methods This was a single-center, assessor-blinded, randomized controlled clinical trial, which screened 179 patients and included 39 PSA subjects, with the registration number ChiCTR2200056393 in China. Demographic and clinical data were documented. The primary outcome was the Western Aphasia Battery (WAB) used to assess language function, and the secondary outcomes included Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) for evaluating cognition, motor, and activities of daily living, respectively. With the computer-generated randomization sequence, subjects were randomly divided into the conventional group (CG), MIT combined with sham stimulation group (SG), and MIT combined with tDCS group (TG). After the three-week intervention, the functional changes in each group were analyzed by the paired sample T-test, and the functional difference between the three groups was analyzed by ANOVA. Results There was no statistical difference on the baseline. After the intervention, the WAB's aphasia quotient (WAB-AQ), MoCA, FMA, and BI were statistically different in SG and TG, including all the sub-items in WAB and FMA, while only listening comprehension, FMA, and BI were statistically different in CG. The differences of WAB-AQ, MoCA, and FMA were statistically different among the three groups, but BI was not. The post hoc test results revealed that the changes of WAB-AQ and MoCA in TG were more significant than the others. Conclusion MIT combined with tDCS can augment the positive effect on language and cognitive recovery in PSA.
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Affiliation(s)
- Zhijie Yan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinyuan He
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mangmang Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaoqing Fan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongshuai Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofang Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hongxia Xing
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jie Jia
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Melodic Intonation Therapy in Post-Stroke Non-Fluent Aphasia and Its Effects on Brain Plasticity. J Clin Med 2022; 11:jcm11123503. [PMID: 35743571 PMCID: PMC9225206 DOI: 10.3390/jcm11123503] [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: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/04/2022] Open
Abstract
Melodic Intonation Therapy (MIT) is one of the most well-known therapies for the rehabilitation of speech in patients with non-fluent aphasia and which is thought to promote right-hemisphere involvement in language processing. This review focuses on the study of language lateralization and/or neuroplastic reorganization with neuroimaging and/or neurophysiological techniques in non-fluent aphasic patients post-stroke during or after MIT. A systematic search was carried out according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in databases (PubMed, Scopus, EMBASE, Dialnet, Web of Science, Cochrane) with the keywords melodic intonation therapy, neuroimaging, functional magnetic resonance, and positron emission tomography and the boolean operators AND and OR. Articles including patients of all ages and either sex with any type of aphasia post-stroke and in any language, which studied language lateralization and/or neuroplastic reorganization after or during MIT were included. Articles which did not achieve the objectives, revisions and conferences were excluded. Different results were obtained from the 16 studies included in the review: predominantly greater activation of the right hemisphere but also of the left hemisphere or both. MIT is an effective therapy to rehabilitate non-fluent aphasic patients post-stroke. It involves different neurobiological mechanisms and depends on multiple individual factors. Studies with larger samples are necessary.
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Xu C, He Z, Shen Z, Huang F. Potential Benefits of Music Therapy on Stroke Rehabilitation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9386095. [PMID: 35757506 PMCID: PMC9217607 DOI: 10.1155/2022/9386095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Stroke is associated with a high rate of disability and mortality, and survivors are usually accompanied with dysphagia, aphasia, motor dysfunction, cognitive impairment, depression, and other complications. In the past decades, many studies have been conducted to reveal the pathogenesis and pathological mechanisms of stroke. Furthermore, treatment methods have been developed that contribute to the elevated survival rate of stroke patients. Early rehabilitation poststroke is starting to be recognized as important and has been receiving increasing attention in order to further improve the quality of life of the patients. As an emerging method of poststroke rehabilitation, music therapy can help attenuate dysphagia and aphasia, improve cognition and motor function, alleviate negative moods, and accelerate neurological recovery in stroke patients. This review helps summarize the recent progress that has been made using music therapy in stroke rehabilitation and is aimed at providing clinical evidence for the treatment of stroke patients.
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Affiliation(s)
- Chengyan Xu
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zixia He
- Department of Outpatient, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhipeng Shen
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Huang
- Department of Science and Education, Hangzhou Women's Hospital, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
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Martin KC, Seydell-Greenwald A, Berl MM, Gaillard WD, Turkeltaub PE, Newport EL. A Weak Shadow of Early Life Language Processing Persists in the Right Hemisphere of the Mature Brain. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:364-385. [PMID: 35686116 PMCID: PMC9169899 DOI: 10.1162/nol_a_00069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Studies of language organization show a striking change in cerebral dominance for language over development: We begin life with a left hemisphere (LH) bias for language processing, which is weaker than that in adults and which can be overcome if there is a LH injury. Over development this LH bias becomes stronger and can no longer be reversed. Prior work has shown that this change results from a significant reduction in the magnitude of language activation in right hemisphere (RH) regions in adults compared to children. Here we investigate whether the spatial distribution of language activation, albeit weaker in magnitude, still persists in homotopic RH regions of the mature brain. Children aged 4-13 (n = 39) and young adults (n = 14) completed an auditory sentence comprehension fMRI (functional magnetic resonance imaging) task. To equate neural activity across the hemispheres, we applied fixed cutoffs for the number of active voxels that would be included in each hemisphere for each participant. To evaluate homotopicity, we generated left-right flipped versions of each activation map, calculated spatial overlap between the LH and RH activity in frontal and temporal regions, and tested for mean differences in the spatial overlap values between the age groups. We found that, in children as well as in adults, there was indeed a spatially intact shadow of language activity in the right frontal and temporal regions homotopic to the LH language regions. After a LH stroke in adulthood, recovering early-life activation in these regions might assist in enhancing recovery of language abilities.
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Affiliation(s)
- Kelly C. Martin
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Madison M. Berl
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - William D. Gaillard
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - Peter E. Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Elissa L. Newport
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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Chang WK, Park J, Lee JY, Cho S, Lee J, Kim WS, Paik NJ. Functional Network Changes After High-Frequency rTMS Over the Most Activated Speech-Related Area Combined With Speech Therapy in Chronic Stroke With Non-fluent Aphasia. Front Neurol 2022; 13:690048. [PMID: 35222235 PMCID: PMC8866644 DOI: 10.3389/fneur.2022.690048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to the lesional hemisphere requires prudence in selecting the appropriate stimulation spot. Functional near-IR spectroscopy (fNIRS) can be used in both selecting the stimulation spot and assessing the changes of the brain network. This study aimed to evaluate the effect of HF-rTMS on the most activated spot identified with fNIRS and assess the changes of brain functional network in the patients with poststroke aphasia. METHODS A total of five patients received HF-rTMS to the most activated area on the lesional hemisphere, followed by 30 min of speech therapy for 10 days. The Korean version of the Western aphasia battery (K-WAB) and fNIRS evaluation were done 1 day before the treatment, 1 day and 1 month after the last treatment session. Changes of K-WAB and paired cortical interaction and brain network analysis using graph theory were assessed. RESULTS Aphasia quotient in K-WAB significantly increased after the treatment (P = 0.043). The correlation analysis of cortical interactions showed increased connectivity between language production and processing areas. Clustering coefficients of the left hemisphere were increased over a sparsity range between 0.45 and 0.58 (0.015 < p < 0.031), whereas the clustering coefficients of the right hemisphere, decreased over a sparsity range 0.15-0.87 (0.063 < p < 0.095). The global efficiency became lower over a network sparsity range between 0.47 and 0.75 (0.015 < p < 0.063). CONCLUSION Improvement of language function and changes of corticocortical interaction between language-related cortical areas were observed after HF-rTMS on the most activated area identified by fNIRS with combined speech therapy in the patients with poststroke aphasia.
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Affiliation(s)
| | | | | | | | | | | | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Zhang X, Li J, Du Y. Melodic Intonation Therapy on Non-fluent Aphasia After Stroke: A Systematic Review and Analysis on Clinical Trials. Front Neurosci 2022; 15:753356. [PMID: 35153655 PMCID: PMC8829877 DOI: 10.3389/fnins.2021.753356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 01/05/2023] Open
Abstract
Melodic intonation therapy (MIT) is a melodic musical training method that could be combined with language rehabilitation. However, some of the existing literature focuses on theoretical mechanism research, while others only focus on clinical behavioral evidence. Few clinical experimental studies can combine the two for behavioral and mechanism analysis. This review aimed at systematizing recent results from studies that have delved explicitly into the MIT effect on non-fluent aphasia by their study design properties, summarizing the findings, and identifying knowledge gaps for future work. MIT clinical trials and case studies were retrieved and teased out the results to explore the validity and relevance of these results. These studies focused on MIT intervention for patients with non-fluent aphasia in stroke recovery period. After retrieving 128 MIT-related articles, 39 valid RCT studies and case reports were provided for analysis. Our summary shows that behavioral measurements at MIT are excessive and provide insufficient evidence of MRI imaging structure. This proves that MIT still needs many MRI studies to determine its clinical evidence and intervention targets. The strengthening of large-scale clinical evidence of imaging observations will result in the clear neural circuit prompts and prediction models proposed for the MIT treatment and its prognosis.
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Affiliation(s)
- Xiaoying Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, China Rehabilitation Research Center, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Department of Psychology, Music Therapy Center, China Rehabilitation Research Center, Beijing, China
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, China Rehabilitation Research Center, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Department of Psychology, Music Therapy Center, China Rehabilitation Research Center, Beijing, China
- Chinese Institute of Rehabilitation Science, Beijing, China
- *Correspondence: Jianjun Li ;
| | - Yi Du
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences (CAS), Beijing, China
- Departments of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Figeys M, Kim ES, Hopper T. Does Right-Hemispheric Anodal tDCS Enhance the Impact of Script Training in Chronic Aphasia? A Single-Subject Experimental Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:793451. [PMID: 36188817 PMCID: PMC9397953 DOI: 10.3389/fresc.2021.793451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022]
Abstract
Background: Script training is an aphasia treatment approach that has been demonstrated to have a positive effect on communication of individuals with aphasia; however, it is time intensive as a therapeutic modality. To augment therapy-induced neuroplasticity, transcranial direct current stimulation (tDCS) may be implemented. tDCS has been paired with other speech-language treatments, however, has not been investigated with script training. Aims: The purpose of this study was to determine if tDCS improves communication proficiency when paired with script training, compared to script training alone. Methods and Procedures: A single-subject experimental design was implemented with a participant with non-fluent aphasia, using two scripts across treatment conditions: script training with sham-tDCS, and script training with anodal-tDCS. Treatment sessions were 75 min long, administered three times weekly. Anodal tDCS was implemented for 20 min with a current of 1.5 mA over the right inferior frontal gyrus. Results: Large effect sizes were obtained on script mastery for both stimulation conditions (anodal d2 = 9.94; sham d2 = 11.93). tDCS did not improve script accuracy, however, there was a significant improvement in the rate of change of script pace relative to baseline (3.99 seconds/day, p < 0.001) in the anodal tDCS condition. Conclusion: Despite a null tDCS result on accuracy, the script training protocol increased script performance to a near-fluent level of communication. There is preliminary evidence to suggest that tDCS may alter the rate of script acquisition, however, further research to corroborate this finding is required. Implications for future studies are discussed.
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Affiliation(s)
- Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Esther Sung Kim
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Esther Sung Kim
| | - Tammy Hopper
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
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12
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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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13
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Haro-Martínez A, Pérez-Araujo CM, Sanchez-Caro JM, Fuentes B, Díez-Tejedor E. Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis. Front Neurol 2021; 12:700115. [PMID: 34421802 PMCID: PMC8371046 DOI: 10.3389/fneur.2021.700115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Melodic intonation therapy (MIT) is one of the most studied speech and language therapy (SLT) approaches for patients with non-fluent aphasia, although the methodological quality of the studies has been rated as low in previous reviews. The aim of this study is to update current evidence on the possible efficacy of MIT for the treatment of non-fluent post-stroke aphasia. Methods: A systematic review and meta-analysis. We selected randomized clinical trials (RCT) that included adult patients over 18 years of age with non-fluent post-stroke aphasia, whose intervention was MIT vs. no therapy or other therapy. We excluded non-RCT studies, mixed populations including patients with aphasia of non-stroke etiology, studies with no availability of post-stroke aphasia-specific data, and incomplete studies. Three sections of communicative ability were analyzed as outcomes: functional communication, expressive language (naming and repetition), and comprehension. Results: We identified a total of four eligible RCTs involving 94 patients. Despite the heterogeneity in the psychometric tests employed among the trials, a significant effect of MIT on functional communication (evaluated by the Communication Activity Log) was found (SMD 1.47; 95% CI 0.39–2.56). In addition, a positive effect of MIT on expressive language (repetition) was found (SMD 0.45; 95% CI 0.01–0.90). No significant effects on comprehension measurements were found, despite a lack of significant statistical heterogeneity. Conclusion: This systematic review and meta-analysis shows a significant effect of MIT on improving functional communication and on repetition tasks. Future larger RCT specifically addressing those outcomes should provide the definite evidence on the efficacy of MIT on post-stroke aphasia recovery. Systematic Review Registration:PROSPERO-URL https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020144604.
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Affiliation(s)
- Ana Haro-Martínez
- Doctoral Programme, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Juan M Sanchez-Caro
- Department of Medicine, Department of Neurology and Stroke Center, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain
| | - Blanca Fuentes
- Department of Medicine, Department of Neurology and Stroke Center, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Medicine, Department of Neurology and Stroke Center, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ Health Research Institute, Madrid, Spain
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14
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Lerud KD, Vines BW, Shinde AB, Schlaug G. Modulating short-term auditory memory with focal transcranial direct current stimulation applied to the supramarginal gyrus. Neuroreport 2021; 32:702-710. [PMID: 33852539 PMCID: PMC8085037 DOI: 10.1097/wnr.0000000000001647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) can affect performance by decreasing regional excitability in a brain region that contributes to the task of interest. To our knowledge, no research to date has found both enhancing and diminishing effects on performance, depending upon which polarity of the current is applied. The supramarginal gyrus (SMG) is an ideal brain region for testing tDCS effects because it is easy to identify using the 10-20 electroencephalography coordinate system, and results of neuroimaging studies have implicated the left SMG in short-term memory for phonological and nonphonological sounds. In the present study, we found that applying tDCS to the left SMG affected pitch memory in a manner that depended upon the polarity of stimulation: cathodal tDCS had a negative impact on performance whereas anodal tDCS had a positive impact. These effects were significantly different from sham stimulation, which did not influence performance; they were also specific to the left hemisphere - no effect was found when applying cathodal stimulation to the right SMG - and were unique to pitch memory as opposed to memory for visual shapes. Our results provide further evidence that the left SMG is a nodal point for short-term auditory storage and demonstrate the potential of tDCS to influence cognitive performance and to causally examine hypotheses derived from neuroimaging studies.
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Affiliation(s)
- Karl D. Lerud
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
| | - Bradley W. Vines
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anant B. Shinde
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Gottfried Schlaug
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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15
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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16
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Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety. Brain Sci 2021; 11:brainsci11010041. [PMID: 33401678 PMCID: PMC7823462 DOI: 10.3390/brainsci11010041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022] Open
Abstract
Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.
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17
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Ihara AS, Miyazaki A, Izawa Y, Takayama M, Hanayama K, Tanemura J. Enhancement of Facilitation Training for Aphasia by Transcranial Direct Current Stimulation. Front Hum Neurosci 2020; 14:573459. [PMID: 33024429 PMCID: PMC7516201 DOI: 10.3389/fnhum.2020.573459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
We aimed to enhance the performance of naming and sentence production in chronic post-stroke aphasia by tablet-based language training combined with transcranial direct current stimulation (tDCS) conducted on non-consecutive days. We applied a deblocking method involved in stimulation–facilitation therapy to six participants with chronic aphasia who performed naming and sentence production tasks for impaired modalities, immediately after a spoken-word picture-matching task for an intact modality. The participants took part in two conditional sessions: a tDCS condition in which they performed a spoken word-picture matching task while we delivered an anodal tDCS over the left inferior frontal cortex; and a sham condition in which sham stimulation was delivered. We hypothesized that, compared with the sham stimulation, the application of anodal tDCS over the left inferior frontal cortex during the performance of tasks requiring access to semantic representations would enhance the deblocking effect, thereby improving the performances for subsequent naming and sentence production. Our results showed greater improvements 2 weeks after training with tDCS than those after training with sham stimulation. The accuracy rate of naming was significantly higher in the tDCS condition than in the sham condition, regardless of whether the words were trained or not. Also, we found a significant improvement in the production of related words and sentences for the untrained words in the tDCS condition, compared with that found pre-training, while in the sham condition we found no significant improvement compared with that found pre-training. These results support our hypothesis and suggest the effectiveness of the use of tDCS during language training on non-consecutive days.
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Affiliation(s)
- Aya S. Ihara
- Center for Information and Neural Networks, National Institute of Information and Communications Technology and Osaka University, Kobe, Japan
- *Correspondence: Aya S. Ihara
| | - Akiko Miyazaki
- Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Yukihiro Izawa
- Department of Childhood Education, Faculty of Education, Fukuyama City University, Fukuyama, Japan
- Department of Rehabilitation, Okayama Rehabilitation Hospital, Okayama, Japan
| | - Misaki Takayama
- Department of Rehabilitation, Okayama Rehabilitation Hospital, Okayama, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Jun Tanemura
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
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18
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Duncan ES, Pradeep AA, Small SL. A Review of Biological Interventions in Chronic Aphasia. Ann Indian Acad Neurol 2020; 23:S82-S94. [PMID: 33343131 PMCID: PMC7731673 DOI: 10.4103/aian.aian_549_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022] Open
Abstract
Aphasia is a common and debilitating condition following stroke. While the gold standard for aphasia treatment is behavioral speech-language therapy, benefits remain modest in chronic stages of recovery. This limitation motivates the pursuit of novel interventions for chronic aphasia. Here, we review biological approaches that have been used (or proposed for use, in the case of regenerative and genetic therapies) to treat chronic aphasia. These techniques aim to ameliorate the deficits of aphasia by directly manipulating brain function, rather than training lost or compensatory functions, although many have been used to augment effects of behavioral therapy. Specifically, we explore the most robust designs of transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and pharmacotherapy that have been applied in chronic (≥6 months) post-stroke aphasia. We also consider less investigated approaches including epidural cortical stimulation and photobiomodulation. All methods are currently in nascent phases and restricted to experimental studies and clinical trials. Although the evidence base remains limited, such interventions may ultimately improve language function and quality of life for those living with chronic aphasia. However, it is crucial that application of these methods consider the effects of concomitant speech-language therapy, as biological interventions combined with behaviorally induced experience-dependent plasticity will likely yield the most beneficial and durable outcomes.
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Affiliation(s)
- E. Susan Duncan
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA,Address for correspondence: Dr. E. Susan Duncan, 74 Hatcher Hall, Louisiana State University, Baton Rouge, LA - 70803, USA. E-mail:
| | - Aswathy Anakkathil Pradeep
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Steven L. Small
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas, USA
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19
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Matar SJ, Sorinola IO, Newton C, Pavlou M. Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults. Front Neurol 2020; 11:935. [PMID: 32982943 PMCID: PMC7479316 DOI: 10.3389/fneur.2020.00935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The use of transcranial direct-current stimulation (tDCS) for therapeutic and neurorehabilitation purposes has become increasingly popular in recent years. Previous research has found that anodal tDCS may enhance naming ability and verbal fluency in healthy participants. However, the effect of tDCS on more functional, higher level language skills such as discourse production has yet to be understood. Aims: The present study aimed to investigate in healthy, older adults (a) the effect of anodal tDCS on discourse production vs. sham stimulation and (b) optimal electrode placement for tDCS to target language improvement at the discourse level. Methods: Fourteen healthy, older right-handed participants took part in this sham controlled, repeated measures pilot study. Each participant experienced three different experimental conditions; anodal tDCS on the left inferior frontal gyrus (IFG), anodal tDCS on the right IFG and sham stimulation while performing a story telling task. Significant changes in language performance before and after each condition were examined in three discourse production tasks: recount, procedural and narrative. Results: Left and right IFG conditions showed a greater number of significant within-group improvements (p < 0.05) in discourse production compared to sham with 6/12 for left IFG, 4/12 for right IFG and 2/12 for sham. There were no significant differences noted between tDCS conditions. No relationship was noted between language performance and physical activity, age, or gender. Conclusions: This study suggests that anodal tDCS may significantly improve discourse production in healthy, older adults. In line with previous tDCS language studies, the left IFG is highlighted as an optimal stimulation site for the modulation of language in healthy speakers. The findings support further exploration of tDCS as a rehabilitative tool for higher-level language skills in persons with aphasia.
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Affiliation(s)
- Shereen J Matar
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Isaac O Sorinola
- Department of Public Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Caroline Newton
- Division of Psychology & Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Marousa Pavlou
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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20
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Bikson M, Hanlon CA, Woods AJ, Gillick BT, Charvet L, Lamm C, Madeo G, Holczer A, Almeida J, Antal A, Ay MR, Baeken C, Blumberger DM, Campanella S, Camprodon JA, Christiansen L, Loo C, Crinion JT, Fitzgerald P, Gallimberti L, Ghobadi-Azbari P, Ghodratitoostani I, Grabner RH, Hartwigsen G, Hirata A, Kirton A, Knotkova H, Krupitsky E, Marangolo P, Nakamura-Palacios EM, Potok W, Praharaj SK, Ruff CC, Schlaug G, Siebner HR, Stagg CJ, Thielscher A, Wenderoth N, Yuan TF, Zhang X, Ekhtiari H. Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic. Brain Stimul 2020; 13:1124-1149. [PMID: 32413554 PMCID: PMC7217075 DOI: 10.1016/j.brs.2020.05.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, MN, Minneapolis, USA
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Adrienn Holczer
- Department of Neurology, Albert Szent-Györgyi Health Center, Faculty of Medicine, University of Szeged, Hungary
| | - Jorge Almeida
- Proaction Lab, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany; Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et D'Addiction, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Place Vangehuchten, B-1020, Brussels, Belgium
| | - Joan A Camprodon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lasse Christiansen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Colleen Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia
| | | | - Peyman Ghobadi-Azbari
- Department of Biomedical Engineering, Shahed University, Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Tehran, Iran
| | - Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory (NEL), Center for Mathematical Sciences Applied to Industry, Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil
| | - Roland H Grabner
- Educational Neuroscience, Institute of Psychology, University of Graz, Austria
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, V. M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Paola Marangolo
- Department of Humanities Studies, University Federico II, Naples, Italy; Aphasia Research Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Weronika Potok
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Gottfried Schlaug
- Neuroimaging-Neuromodulation and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Baystate Medical Center, UMass Medical School, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging and MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Science and Technology, ETH Zurich, Switzerland
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochu Zhang
- CAS Key Laboratory of Brain Function and Disease and School of Life Sciences, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, China
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Management of Cognitive Impairment After Stroke. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hartwigsen G, Stockert A, Charpentier L, Wawrzyniak M, Klingbeil J, Wrede K, Obrig H, Saur D. Short-term modulation of the lesioned language network. eLife 2020; 9:54277. [PMID: 32181741 PMCID: PMC7077979 DOI: 10.7554/elife.54277] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Language is sustained by large-scale networks in the human brain. Stroke often severely affects function and network dynamics. However, the adaptive potential of the brain to compensate for lesions is poorly understood. A key question is whether upregulation of the right hemisphere is adaptive for language recovery. Targeting the potential for short-term reorganization in the lesioned brain, we applied 'virtual lesions' over left anterior or posterior inferior frontal gyrus (IFG) in post-stroke patients with left temporo-parietal lesions prior to functional neuroimaging. Perturbation of the posterior IFG selectively delayed phonological decisions and decreased phonological activity. The individual response delay was correlated with the upregulation of the lesion homologue, likely reflecting compensation. Moreover, stronger individual tract integrity of the right superior longitudinal fascicle was associated with lesser disruption. Our results provide evidence for functional and structural underpinnings of plasticity in the lesioned language network, and a compensatory role of the right hemisphere.
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Affiliation(s)
- Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Leipzig, Germany
| | - Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Louise Charpentier
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Leipzig, Germany
| | - Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Katrin Wrede
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Hellmuth Obrig
- Clinic for Cognitive Neurology, University of Leipzig Medical Centre & Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Centre, Leipzig, Germany
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Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study. J Int Neuropsychol Soc 2020; 26:7-18. [PMID: 31983371 DOI: 10.1017/s1355617719001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia. METHODS In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question "what is your job." RESULTS There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred. CONCLUSION Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.
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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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Artificial grammar learning with transcranial direct current stimulation (tDCS): A pilot study. Brain Stimul 2019; 12:1307-1308. [PMID: 31300247 DOI: 10.1016/j.brs.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 11/22/2022] Open
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Cochrane Database Syst Rev 2019; 5:CD009760. [PMID: 31111960 PMCID: PMC6528187 DOI: 10.1002/14651858.cd009760.pub4] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide and aphasia among survivors is common. Current speech and language therapy (SLT) strategies have only limited effectiveness in improving aphasia. A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability and hence to improve aphasia. OBJECTIVES To assess the effects of tDCS for improving aphasia in people who have had a stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (June 2018), CENTRAL (Cochrane Library, June 2018), MEDLINE (1948 to June 2018), Embase (1980 to June 2018), CINAHL (1982 to June 2018), AMED (1985 to June 2018), Science Citation Index (1899 to June 2018), and seven additional databases. We also searched trial registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers. SELECTION CRITERIA We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials (from which we only analysed the first period as a parallel group design) comparing tDCS versus control in adults with aphasia due to stroke. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and risk of bias, and extracted data. If necessary, we contacted study authors for additional information. We collected information on dropouts and adverse events from the trials. MAIN RESULTS We included 21 trials involving 421 participants in the qualitative synthesis. Three studies with 112 participants used formal outcome measures for our primary outcome measure of functional communication - that is, measuring aphasia in a real-life communicative setting. There was no evidence of an effect (standardised mean difference (SMD) 0.17, 95% confidence interval (CI) -0.20 to 0.55; P = 0.37; I² = 0%; low quality of evidence; inverse variance method with random-effects model; higher SMD reflecting benefit from tDCS; moderate quality of evidence). At follow-up, there also was no evidence of an effect (SMD 0.14, 95% CI -0.31 to 0.58; P = 0.55; 80 participants ; 2 studies; I² = 0%; very low quality of evidence; higher SMD reflecting benefit from tDCS; moderate quality of evidence).For our secondary outcome measure, accuracy in naming nouns at the end of intervention, there was evidence of an effect (SMD 0.42, 95% CI 0.19 to 0.66; P = 0.0005; I² = 0%; 298 participants; 11 studies; inverse variance method with random-effects model; higher SMD reflecting benefit from tDCS; moderate quality of evidence). There was an effect for the accuracy in naming nouns at follow-up (SMD 0.87, 95% CI 0.25 to 1.48; P = 0.006; 80 participants; 2 studies; I² = 32%; low quality of evidence); however the results were not statistically significant in our sensitivity analysis regarding the assumptions of the underlying correlation coefficient for imputing missing standard deviations of change scores. There was no evidence of an effect regarding accuracy in naming verbs post intervention (SMD 0.19, 95% CI -0.68 to 1.06; P = 0.67; I² = 0%; 21 participants; 3 studies; very low quality of evidence). We found no studies examining the effect of tDCS on cognition in people with aphasia after stroke. We did not find reported serious adverse events and the proportion of dropouts and adverse events was comparable between groups (odds ratio (OR) 0.54, 95% CI 0.21 to 1.37; P = 0.19; I² = 0%; Mantel-Haenszel method with random-effects model; 345 participants; 15 studies; low quality of evidence). AUTHORS' CONCLUSIONS Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS and Dual-tDCS) versus control (sham tDCS) for improving functional communication in people with aphasia after stroke (low quality of evidence). However, there is limited evidence that tDCS may improve naming performance in naming nouns (moderate quality of evidence), but not verbs (very low quality of evidence) at the end of the intervention period and possibly also at follow-up. Further methodologically rigorous RCTs with adequate sample size calculation are needed in this area to determine the effectiveness of this intervention. Data on functional communication and on adverse events should routinely be collected and presented in further publications as well as data at follow-up. Further study on the relationship between language/aphasia and cognition may be required, and improved cognitive assessments for patients with aphasia developed, prior to the use of tDCS to directly target cognition in aphasia. Authors should state total values at post-intervention as well as their corresponding change scores with standard deviations.
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Affiliation(s)
- Bernhard Elsner
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
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Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review. Ann Phys Rehabil Med 2019; 62:104-121. [DOI: 10.1016/j.rehab.2019.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 01/30/2023]
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Heikkinen PH, Pulvermüller F, Mäkelä JP, Ilmoniemi RJ, Lioumis P, Kujala T, Manninen RL, Ahvenainen A, Klippi A. Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial. Front Neurosci 2019; 12:1036. [PMID: 30778280 PMCID: PMC6369187 DOI: 10.3389/fnins.2018.01036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex—that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03629665
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Affiliation(s)
- Paula H Heikkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Teija Kujala
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta-Leena Manninen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Ahvenainen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Klippi
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Al-Shdifat KG, Sarsak J, Ghareeb FA. Exploring the efficacy of melodic intonation therapy with Broca's aphasia in Arabic. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2018; 65:e1-e8. [PMID: 29943587 PMCID: PMC6018128 DOI: 10.4102/sajcd.v65i1.567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 02/09/2018] [Accepted: 03/07/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Even though the efficacy of melodic intonation therapy (MIT) with persons with aphasia (PWA) has been explored in different languages, the efficacy of MIT with Arabic-speaking PWA has never been explored. Aims: To explore the efficacy of MIT, adapted to Arabic, in promoting the expressive abilities of a 70-year-old Jordanian Arabic-speaking male subject with severe Broca's aphasia 3 months post-onset. Methods: An 8-week MIT therapy programme with tapping (1.5 h daily, 6 days a week) was used in a multiple baseline design across two types of trained phrases (i.e. automatic and self-generated phrases). Outcome measures included accuracy of production of trained (at the end of each session) and untrained phrases (at the end of each week). Pre- and post-treatment measures used, were the bilingual aphasia test, the American Speech-Language Hearing Association Functional Assessment of Communicative Skills, the communicative effectiveness index and the American Speech and Hearing Association Quality of Communication Life Scale. Accuracy of production for the trained and untrained phrases was also measured 2 weeks and 4 weeks after the treatment programme was finished. Results: The patient, (MK), improved his expressive productions post-treatment in automatic and self-generated phrases. Automatic phrases exceeded the established 75% accuracy criterion, whereas the self-generated phrases reached criterion and remained constant at follow-up. Moreover, MK gradually started improving on the generalisation stimuli, once the treatment on the self-generated phrases started and maintained the gains 2 weeks and 4 weeks post-treatment. Conclusion: MIT appears to be a viable treatment option for Jordanian Arabic-speaking persons with Broca's aphasia. However, more research is needed with larger groups of Jordanian Arabic-speaking persons with Broca's aphasia to provide more support to the present findings. Moreover, future studies might focus on the efficacy of MIT with persons with Broca's aphasia from different Arab countries and from countries where Arabic is part of the multicultural structure like South Africa and other countries on the African continent.
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Affiliation(s)
- Khalid G Al-Shdifat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology.
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Changes in Resting-State Connectivity following Melody-Based Therapy in a Patient with Aphasia. Neural Plast 2018; 2018:6214095. [PMID: 29796017 PMCID: PMC5896238 DOI: 10.1155/2018/6214095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/19/2017] [Accepted: 01/24/2018] [Indexed: 11/17/2022] Open
Abstract
Melody-based treatments for patients with aphasia rely on the notion of preserved musical abilities in the RH, following left hemisphere damage. However, despite evidence for their effectiveness, the role of the RH is still an open question. We measured changes in resting-state functional connectivity following melody-based intervention, to identify lateralization of treatment-related changes. A patient with aphasia due to left frontal and temporal hemorrhages following traumatic brain injuries (TBI) more than three years earlier received 48 sessions of melody-based intervention. Behavioral measures improved and were maintained at the 8-week posttreatment follow-up. Resting-state fMRI data collected before and after treatment showed an increase in connectivity between motor speech control areas (bilateral supplementary motor areas and insulae) and RH language areas (inferior frontal gyrus pars triangularis and pars opercularis). This change, which was specific for the RH, was greater than changes in a baseline interval measured before treatment. No changes in RH connectivity were found in a matched control TBI patient scanned at the same intervals. These results are compatible with a compensatory role for RH language areas following melody-based intervention. They further suggest that this therapy intervenes at the level of the interface between language areas and speech motor control areas necessary for language production.
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Zheng X, Dai W, Alsop DC, Schlaug G. Modulating transcallosal and intra-hemispheric brain connectivity with tDCS: Implications for interventions in Aphasia. Restor Neurol Neurosci 2018; 34:519-30. [PMID: 27472845 DOI: 10.3233/rnn-150625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Transcranial direct current stimulation (tDCS) can enhance or diminish cortical excitability levels depending on the polarity of the stimulation. One application of non-invasive brain-stimulation has been to modulate a possible inter-hemispheric disinhibition after a stroke. This disinhibition model has been developed mainly for the upper extremity motor system, but it is not known whether the language/speech-motor system shows a similar inter-hemispheric interaction. We aimed to examine physiological evidence of inter- and intra-hemispheric connectivity changes induced by tDCS of the right inferior frontal gyrus (IFG) using arterial-spin labeling (ASL) MRI. METHODS Using an MR-compatible DC-Stimulator, we applied anodal stimulation to the right IFG region of nine healthy adults while undergoing non-invasive cerebral blood flow imaging with arterial-spin labeling (ASL) before, during, and after the stimulation. All ASL images were then normalized and timecourses were extracted in regions of interest (ROIs), which were the left and right IFG regions, and the right supramarginal gyrus (SMG) in the inferior parietal lobule. Two additional ROIs (the right occipital lobe and the left fronto-orbital region) were taken as control regions. RESULTS Using regional correlation coefficients as a surrogate marker of connectivity, we could show that inter-hemispheric connectivity (right IFG with left IFG) decreased significantly (p < 0.05; r-scores from 0.67 to 0.53) between baseline and post-stimulation, while the intra-hemispheric connectivity (right IFG with right SMG) increased significantly (p < 0.05;r-scores from 0.74 to 0.81). A 2 × 2 ANOVA found a significant main effect of HEMISPHERE (F(8) = 6.83, p < 0.01) and a significant HEMISPHERE-by-TIME interaction (F(8) = 4.24, p < 0.05) in connectivity changes. The correlation scores did not change significantly in the control region pairs (right IFG with right occipital and right IFG with left fronto-orbital) over time. CONCLUSION Using an MR-compatible DC stimulator we showed that ASL-MRI can detect tDCS-induced modulation of brain connectivity within and between hemispheres. These findings might affect trial designs focusing on modulating the non-dominant hemisphere to enhance language/speech-motor functions.
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Affiliation(s)
- Xin Zheng
- Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Weiying Dai
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Gottfried Schlaug
- Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND Post-stroke aphasia syndromes as a clinical entity arise from the disruption of brain networks specialized in language production and comprehension due to permanent focal ischemia. This approach to post-stroke aphasia is based on two pathophysiological concepts: 1) Understanding language processing in terms of distributed networks rather than language centers and 2) understanding the molecular pathophysiology of ischemic brain injury as a dynamic process beyond the direct destruction of network centers and their connections. While considerable progress has been made in the past 10 years to develop such models on a systems as well as a molecular level, the influence of these approaches on understanding and treating clinical aphasia syndromes has been limited. OBJECTIVE & METHODS In this article, we review current pathophysiological concepts of ischemic brain injury, their relationship to altered information processing in language networks after ischemic stroke and how these mechanisms may be influenced therapeutically to improve treatment of post-stroke aphasia. CONCLUSION Understanding the pathophysiological mechanism of post-stroke aphasia on a neurophysiological systems level as well as on the molecular level becomes more and more important for aphasia treatment, as the field moves from standardized therapies towards more targeted individualized treatment strategies comprising behavioural therapies as well as non-invasive brain stimulation (NIBS).
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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: 130] [Impact Index Per Article: 18.6] [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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Keser Z, Dehgan MW, Shadravan S, Yozbatiran N, Maher LM, Francisco GE. Combined Dextroamphetamine and Transcranial Direct Current Stimulation in Poststroke Aphasia. Am J Phys Med Rehabil 2017. [PMID: 28632508 DOI: 10.1097/phm.0000000000000780] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a growing need for various effective adjunctive treatment options for speech recovery after stroke. A pharmacological agent combined with noninvasive brain stimulation has not been previously reported for poststroke aphasia recovery. In this "proof of concept" study, we aimed to test the safety of a combined intervention consisting of dextroamphetamine, transcranial direct current stimulation, and speech and language therapy in subjects with nonfluent aphasia. Ten subjects with chronic nonfluent aphasia underwent two experiments where they received dextroamphetamine or placebo along with transcranial direct current stimulation and speech and language therapy on two separate days. The Western Aphasia Battery-Revised was used to monitor changes in speech performance. No serious adverse events were observed. There was no significant increase in blood pressure with amphetamine or deterioration in speech and language performance. Western Aphasia Battery-Revised aphasia quotient and language quotient showed a statistically significant increase in the active experiment. Comparison of proportional changes of aphasia quotient and language quotient in active experiment with those in placebo experiment showed significant difference. We showed that the triple combination therapy is safe and implementable and seems to induce positive changes in speech and language performance in the patients with chronic nonfluent aphasia due to stroke.
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Affiliation(s)
- Zafer Keser
- From the Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center and TIRR Memorial Hermann NeuroRecovery Research Center, Houston, Texas (ZK, NY, GEF); Speech-Language Pathology Department, TIRR Memorial Hermann Hospital, Houston, Texas (MWD, SS); and Department of Communication Sciences and Disorders, University of Houston, Texas (LMM)
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Pierce JE, Menahemi-Falkov M, O’Halloran R, Togher L, Rose ML. Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis. Neuropsychol Rehabil 2017; 29:1005-1041. [DOI: 10.1080/09602011.2017.1365730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- John E. Pierce
- School of Allied Health, La Trobe University, Melbourne, Australia
- Speech Pathology, Cabrini Health, Melbourne, Australia
| | | | - Robyn O’Halloran
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Miranda L. Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
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Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother 2017; 17:1091-1107. [PMID: 28847186 DOI: 10.1080/14737175.2017.1373020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Aphasia is among the most debilitating outcomes of stroke. Aphasia is a language disorder occurring in 10-30% of stroke survivors. Speech and Language Therapy (SLT) is the gold standard, mainstay treatment for aphasia, but gains from SLT may be incomplete. Pharmaceutical and noninvasive brain stimulation (NIBS) techniques may augment the effectiveness of SLT. Areas covered: Herein reviewed are studies of the safety and efficacy of these adjunctive interventions for aphasia, including randomized placebo-controlled and open-label trials, as well as case series from Pubmed, using search terms 'pharmacological,' 'tDCS' or 'TMS' combined with 'aphasia' and 'stroke.' Expert commentary: Relatively small studies have included participants with a range of aphasia types and severities, using inconsistent interventions and outcome measures. Results to-date have provided promising, but weak to moderate evidence that medications and/or NIBS can augment the effects of SLT for improving language outcomes. We end with recommendations for future approaches to studying these interventions, with multicenter, double-blind, randomized controlled trials.
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Affiliation(s)
- Sadhvi Saxena
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Argye E Hillis
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Berthier ML, De-Torres I, Paredes-Pacheco J, Roé-Vellvé N, Thurnhofer-Hemsi K, Torres-Prioris MJ, Alfaro F, Moreno-Torres I, López-Barroso D, Dávila G. Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts. Front Hum Neurosci 2017; 11:304. [PMID: 28659776 PMCID: PMC5470532 DOI: 10.3389/fnhum.2017.00304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022] Open
Abstract
Donepezil (DP), a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014). Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia). A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day) which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy) during 8 weeks (Endpoint 1). Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR) during 3 months (Endpoint 2). Language evaluations, diffusion weighted imaging (DWI), and voxel-based morphometry (VBM) were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these tracts. In conclusion, cholinergic potentiation alone and combined with a model-based aphasia therapy improved language deficits by promoting structural plastic changes in right white matter tracts.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain
| | - Irene De-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Unit of Physical Medicine and Rehabilitation, Regional University Hospital, MalagaMalaga, Spain
| | - José Paredes-Pacheco
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Karl Thurnhofer-Hemsi
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain.,Department of Computer Languages and Computer Science, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain
| | - María J Torres-Prioris
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Francisco Alfaro
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Ignacio Moreno-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Spanish Language I, University of MalagaMalaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
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Hung J, Bauer A, Grossman M, Hamilton RH, Coslett HB, Reilly J. Semantic Feature Training in Combination with Transcranial Direct Current Stimulation (tDCS) for Progressive Anomia. Front Hum Neurosci 2017; 11:253. [PMID: 28559805 PMCID: PMC5432627 DOI: 10.3389/fnhum.2017.00253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 04/27/2017] [Indexed: 01/08/2023] Open
Abstract
We examined the effectiveness of a 2-week regimen of a semantic feature training in combination with transcranial direct current stimulation (tDCS) for progressive naming impairment associated with primary progressive aphasia (N = 4) or early onset Alzheimer's Disease (N = 1). Patients received a 2-week regimen (10 sessions) of anodal tDCS delivered over the left temporoparietal cortex while completing a language therapy that consisted of repeated naming and semantic feature generation. Therapy targets consisted of familiar people, household items, clothes, foods, places, hygiene implements, and activities. Untrained items from each semantic category provided item level controls. We analyzed naming accuracies at multiple timepoints (i.e., pre-, post-, 6-month follow-up) via a mixed effects logistic regression and individual differences in treatment responsiveness using a series of non-parametric McNemar tests. Patients showed advantages for naming trained over untrained items. These gains were evident immediately post tDCS. Trained items also showed a shallower rate of decline over 6-months relative to untrained items that showed continued progressive decline. Patients tolerated stimulation well, and sustained improvements in naming accuracy suggest that the current intervention approach is viable. Future implementation of a sham control condition will be crucial toward ascertaining whether neurostimulation and behavioral treatment act synergistically or alternatively whether treatment gains are exclusively attributable to either tDCS or the behavioral intervention.
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Affiliation(s)
- Jinyi Hung
- Eleanor M. Saffran Center for Cognitive Neuroscience, Temple University, PhiladelphiaPA, USA
- Department of Communication Sciences and Disorders, Temple University, PhiladelphiaPA, USA
| | - Ashley Bauer
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA, USA
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA, USA
| | - Roy H. Hamilton
- Center for Cognitive Neuroscience, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA, USA
| | - H. B. Coslett
- Center for Cognitive Neuroscience, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA, USA
| | - Jamie Reilly
- Eleanor M. Saffran Center for Cognitive Neuroscience, Temple University, PhiladelphiaPA, USA
- Department of Communication Sciences and Disorders, Temple University, PhiladelphiaPA, USA
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Norise C, Hamilton RH. Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned. Front Hum Neurosci 2017; 10:675. [PMID: 28167904 PMCID: PMC5253356 DOI: 10.3389/fnhum.2016.00675] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
Numerous studies over the span of more than a decade have shown that non-invasive brain stimulation (NIBS) techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate language recovery for patients who have suffered from aphasia due to stroke. While stroke is the most common etiology of aphasia, neurodegenerative causes of language impairment—collectively termed primary progressive aphasia (PPA)—are increasingly being recognized as important clinical phenotypes in dementia. Very limited data now suggest that (NIBS) may have some benefit in treating PPAs. However, before applying the same approaches to patients with PPA as have previously been pursued in patients with post-stroke aphasia, it will be important for investigators to consider key similarities and differences between these aphasia etiologies that is likely to inform successful approaches to stimulation. While both post-stroke aphasia and the PPAs have clear overlaps in their clinical phenomenology, the mechanisms of injury and theorized neuroplastic changes associated with the two etiologies are notably different. Importantly, theories of plasticity in post-stroke aphasia are largely predicated on the notion that regions of the brain that had previously been uninvolved in language processing may take on new compensatory roles. PPAs, however, are characterized by slow distributed degeneration of cellular units within the language system; compensatory recruitment of brain regions to subserve language is not currently understood to be an important aspect of the condition. This review will survey differences in the mechanisms of language representation between the two etiologies of aphasia and evaluate properties that may define and limit the success of different neuromodulation approaches for these two disorders.
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Affiliation(s)
- Catherine Norise
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
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Costanzo F, Varuzza C, Rossi S, Sdoia S, Varvara P, Oliveri M, Giacomo K, Vicari S, Menghini D. Evidence for reading improvement following tDCS treatment in children and adolescents with Dyslexia. Restor Neurol Neurosci 2016; 34:215-26. [PMID: 26890096 DOI: 10.3233/rnn-150561] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE There is evidence that non-invasive brain stimulation transitorily modulates reading by facilitating the neural pathways underactive in individuals with dyslexia. The study aimed at investigating whether multiple sessions of transcranial direct current stimulation (tDCS) would enhance reading abilities of children and adolescents with dyslexia and whether the effect is long-lasting. METHODS Eighteen children and adolescents with dyslexia received three 20-minute sessions a week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS set at 1 mA over parieto-temporal regions combined with a cognitive training. The participants were randomly assigned to the active or the sham treatment; reading tasks (text, high and low frequency words, non-words) were used as outcome measures and collected before treatment, after treatment and one month after the end of treatment. The tolerability of tDCS was evaluated. RESULTS The active group showed reduced low frequency word reading errors and non-word reading times. These positive effects were stable even one month after the end of treatment. None reported adverse effects. CONCLUSIONS The study shows preliminary evidence of tDCS feasibility and efficacy in improving non-words and low frequency words reading of children and adolescents with dyslexia and it opens new rehabilitative perspectives for the remediation of dyslexia.
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Affiliation(s)
- Floriana Costanzo
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | - Cristiana Varuzza
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | - Serena Rossi
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | - Stefano Sdoia
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | - Pamela Varvara
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | | | - Koch Giacomo
- Clinical and Behavioral Neurology, Santa Lucia Foundation, Rome, Italy
| | - Stefano Vicari
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
| | - Deny Menghini
- Child Neuropsychiatric Unit, Bambino Gesù Children Hospital, Department of Neuroscience, Piazza Sant'Onofrio 4, Rome, Italy
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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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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1017] [Impact Index Per Article: 127.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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Tabei KI, Satoh M, Nakano C, Ito A, Shimoji Y, Kida H, Sakuma H, Tomimoto H. Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study. Front Neurol 2016; 7:148. [PMID: 27698650 PMCID: PMC5027199 DOI: 10.3389/fneur.2016.00148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load.
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Affiliation(s)
- Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan; Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Chizuru Nakano
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Ai Ito
- Department of Neurology, Graduate School of Medicine, Mie University , Mie , Japan
| | - Yasuo Shimoji
- Department of Rehabilitation, Suzuka Central General Hospital , Mie , Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Hajime Sakuma
- Department of Radiology, Graduate School of Medicine, Mie University , Mie , Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan; Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
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Shah-Basak PP, Wurzman R, Purcell JB, Gervits F, Hamilton R. Fields or flows? A comparative metaanalysis of transcranial magnetic and direct current stimulation to treat post-stroke aphasia. Restor Neurol Neurosci 2016; 34:537-58. [PMID: 27163249 DOI: 10.3233/rnn-150616] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Rachel Wurzman
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Juliann B. Purcell
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Felix Gervits
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Hamilton
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Marini A, Galetto V, Tatu K, Duca S, Geminiani G, Sacco K, Zettin M. Recovering two languages with the right hemisphere. BRAIN AND LANGUAGE 2016; 159:35-44. [PMID: 27289209 DOI: 10.1016/j.bandl.2016.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 02/26/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
Converging evidence suggests that the right hemisphere (RH) plays an important role in language recovery from aphasia after a left hemisphere (LH) lesion. In this longitudinal study we describe the neurological, cognitive, and linguistic profile of A.C., a bilingual who, after a severe traumatic brain injury, developed a form of fluent aphasia that affected his two languages (i.e., Romanian and Italian). The trauma-induced parenchymal atrophy led to an exceptional ventricular dilation that, gradually, affected the whole left hemisphere. A.C. is now recovering both languages relying only on his right hemisphere. An fMRI experiment employing a bilingual covert verb generation task documented the involvement of the right middle temporal gyrus in processes of lexical selection and access. This case supports the hypothesis that the RH plays a role in language recovery from aphasia when the LH has suffered massive lesions.
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Affiliation(s)
- Andrea Marini
- Dipartimento di Lingue e Letterature, Comunicazione, Formazione e Società, University of Udine, Udine, Italy; Scientific Institute, IRCCS Eugenio Medea, San Vito al Tagliamento, Pordenone, Italy; Claudiana - Landesfachhochschule für Gesundheitsberufe, Bolzano, Italy.
| | - Valentina Galetto
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy
| | - Karina Tatu
- Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy
| | | | - Giuliano Geminiani
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Katiuscia Sacco
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Marina Zettin
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy.
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Cappon D, Jahanshahi M, Bisiacchi P. Value and Efficacy of Transcranial Direct Current Stimulation in the Cognitive Rehabilitation: A Critical Review Since 2000. Front Neurosci 2016; 10:157. [PMID: 27147949 PMCID: PMC4834357 DOI: 10.3389/fnins.2016.00157] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/27/2016] [Indexed: 12/02/2022] Open
Abstract
Non-invasive brain stimulation techniques, including transcranial direct current stimulation (t-DCS) have been used in the rehabilitation of cognitive function in a spectrum of neurological disorders. The present review outlines methodological communalities and differences of t-DCS procedures in neurocognitive rehabilitation. We consider the efficacy of tDCS for the management of specific cognitive deficits in four main neurological disorders by providing a critical analysis of recent studies that have used t-DCS to improve cognition in patients with Parkinson's Disease, Alzheimer's Disease, Hemi-spatial Neglect, and Aphasia. The evidence from this innovative approach to cognitive rehabilitation suggests that tDCS can influence cognition. However, the results show a high variability between studies both in terms of the methodological approach adopted and the cognitive functions targeted. The review also focuses both on methodological issues such as technical aspects of the stimulation (electrode position and dimension; current intensity; duration of protocol) and on the inclusion of appropriate assessment tools for cognition. A further aspect considered is the optimal timing for administration of tDCS: before, during or after cognitive rehabilitation. We conclude that more studies using common methodology are needed to gain a better understanding of the efficacy of tDCS as a new tool for rehabilitation of cognitive disorders in a range of neurological disorders.
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Affiliation(s)
- Davide Cappon
- Department of General Psychology, Center for Cognitive Neuroscience, University of Padova Padua, Italy
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London London, UK
| | - Patrizia Bisiacchi
- Department of General Psychology, Center for Cognitive Neuroscience, University of Padova Padua, Italy
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Crinion JT. Transcranial Direct Current Stimulation as a Novel Method for Enhancing Aphasia Treatment Effects. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Neuromodulation is an exciting area of development. Currently, there is significant interest in academia, industry, and clinical practice where an effective and acceptable transcranial direct current stimulation (tDCS) kit for use in clinical rehabilitation would offer much benefit to patients’ treatment. In this review, I discuss the latest group studies investigating current tDCS methods for enhancing aphasia treatment effects in post-stroke (sub-acute and chronic) and primary progressive aphasia (PPA) patient populations. This field is still new, and many more investigations with larger samples of patients are needed. Nevertheless, in the studies completed to date, on-line tDCS paired with language rehabilitation was feasible, safe, well tolerated, and sham controlled. Results on the effectiveness of tDCS at boosting recovery outcomes are preliminary but promising with a number of themes emerging. I highlight some of these themes and future directions toward identifying those patients who are likely to respond to specific tDCS and behavioral therapies. This would provide an empirical basis from which to investigate specific aphasia interventions in future multicenter clinical trials and could greatly improve the quality of aphasia treatment for stroke and PPA patients.
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