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Contrada M, Scarfone F, Iozzi A, Carozzo S, Vatrano M, Nicoletta MG, Nudo G, Quintieri M, Tonin P, Cerasa A. Combining computer-based rehabilitative approach with tDCS for recovering of aphasia: Implications from a single case study. Clin Case Rep 2024; 12:e8928. [PMID: 38799514 PMCID: PMC11111603 DOI: 10.1002/ccr3.8928] [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: 01/24/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
We present a case of a single left hemisphere temporal-parietal stroke with subacute global aphasia and severe verbal apraxia and moderate dysphagia. The patient underwent a combined transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) and language stimulation with Virtual Reality Rehabilitation System (VRRS). Patient was treated in a 1-h session, for 5 days a week, for 4 consecutive weeks. After treatment, evident improvements in the comprehension of oral and written language, swallowing abilities, and caregiver burden were detected. Power spectrum analysis of EEG data revealed significant enhancements of θ, α, and β waves from baseline to follow-up. These preliminary results seem to confirm the reliability of the tDCS translational application in conjunction with computer-based cognitive treatment for language disorders in a patient with stroke-induced aphasia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonio Cerasa
- S. Anna InstituteCrotoneItaly
- Institute for Biomedical Research and Innovation (IRIB)National Research Council of Italy (CNR)MessinaItaly
- Department of Pharmacy, Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Health Science and NutritionUniversity of CalabriaRendeItaly
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Tilton-Bolowsky VE, Hillis AE. A Review of Poststroke Aphasia Recovery and Treatment Options. Phys Med Rehabil Clin N Am 2024; 35:419-431. [PMID: 38514227 DOI: 10.1016/j.pmr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.
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Affiliation(s)
- Victoria E Tilton-Bolowsky
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA.
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Zeng Y, Tang Q, Chen S, Chen X. Integration of a large language model with augmentative and alternative communication tool for oncological aphasia rehabilitation. Asia Pac J Oncol Nurs 2024; 11:100344. [PMID: 38283666 PMCID: PMC10821375 DOI: 10.1016/j.apjon.2023.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Yingchun Zeng
- Affiliated Hospital, Hangzhou City University, Hangzhou, China
| | - Qi Tang
- School of Medicine, Hangzhou City University, Hangzhou, China
| | - Shuchang Chen
- School of Medicine, Hangzhou City University, Hangzhou, China
| | - Xiaoqin Chen
- Affiliated Hospital, Hangzhou City University, Hangzhou, China
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Li B, Deng S, Zhuo B, Sang B, Chen J, Zhang M, Tian G, Zhang L, Du Y, Zheng P, Yue G, Meng Z. Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352580. [PMID: 38252438 PMCID: PMC10804271 DOI: 10.1001/jamanetworkopen.2023.52580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
Importance Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. Objective To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia. Design, Setting, and Participants This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023. Interventions Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments. Main Outcomes and Measures The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle. Results Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up. Conclusions and Relevance In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset. Trial Registration Chinese Clinical Trial Registry: ChiCTR1900026740.
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Affiliation(s)
- Boxuan Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shizhe Deng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bifang Zhuo
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bomo Sang
- Air Force Medical Center of People’s Liberation Army, Beijing, China
| | - Junjie Chen
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Menglong Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guang Tian
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lili Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuzheng Du
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Peng Zheng
- Changchun University of Chinese Medicine, Changchun, China
| | - Gonglei Yue
- Qilu Hospital of Shandong University, Shandong, China
| | - Zhihong Meng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Cao Y, Fan C, Li G, Huang J, Zhang J. A computer-aid speech rehabilitation system with mirrored video generating. Technol Health Care 2024; 32:543-553. [PMID: 38759075 PMCID: PMC11191434 DOI: 10.3233/thc-248047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Aphasia is a communication disorder that affects the ability to process and produce language, which severely impacting their lives. Computer-aid exercise rehabilitation has shown to be highly effective for these patients. OBJECTIVE In our study, we proposed a speech rehabilitation system with mirrored therapy. The study goal is to construct a effective rehabilitation software for aphasia patients. METHODS This system collects patients' facial photos for mirrored video generation and speech synthesis. The visual feedback provided by the mirror creates an engaging and motivating experience for patients. And the evaluation platform employs machine learning technologies for assessing speech similarity. RESULTS The sophisticated task-oriented rehabilitation training with mirror therapy is also presented for experiments performing. The performance of three tasks reaches the average scores of 83.9% for vowel exercises, 74.3% for word exercies and 77.8% for sentence training in real time. CONCLUSIONS The user-friendly application system allows patients to carry out daily training tasks instructed by the therapists or the prompt information of menu. Our work demonstrated a promising intelligent mirror software system for reading-based aphasia rehabilitation.
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Affiliation(s)
- Yang Cao
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Chunjiang Fan
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Gang Li
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jian Huang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jinli Zhang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
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Hummel E, Cogne M, Lange M, Lecuyer A, Joly F, Gouranton V. VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4167-4178. [PMID: 37862281 DOI: 10.1109/tnsre.2023.3324131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.
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Ibáñez A, Kühne K, Miklashevsky A, Monaco E, Muraki E, Ranzini M, Speed LJ, Tuena C. Ecological Meanings: A Consensus Paper on Individual Differences and Contextual Influences in Embodied Language. J Cogn 2023; 6:59. [PMID: 37841670 PMCID: PMC10573819 DOI: 10.5334/joc.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2023] Open
Abstract
Embodied theories of cognition consider many aspects of language and other cognitive domains as the result of sensory and motor processes. In this view, the appraisal and the use of concepts are based on mechanisms of simulation grounded on prior sensorimotor experiences. Even though these theories continue receiving attention and support, increasing evidence indicates the need to consider the flexible nature of the simulation process, and to accordingly refine embodied accounts. In this consensus paper, we discuss two potential sources of variability in experimental studies on embodiment of language: individual differences and context. Specifically, we show how factors contributing to individual differences may explain inconsistent findings in embodied language phenomena. These factors include sensorimotor or cultural experiences, imagery, context-related factors, and cognitive strategies. We also analyze the different contextual modulations, from single words to sentences and narratives, as well as the top-down and bottom-up influences. Similarly, we review recent efforts to include cultural and language diversity, aging, neurodegenerative diseases, and brain disorders, as well as bilingual evidence into the embodiment framework. We address the importance of considering individual differences and context in clinical studies to drive translational research more efficiently, and we indicate recommendations on how to correctly address these issues in future research. Systematically investigating individual differences and context may contribute to understanding the dynamic nature of simulation in language processes, refining embodied theories of cognition, and ultimately filling the gap between cognition in artificial experimental settings and cognition in the wild (i.e., in everyday life).
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Affiliation(s)
- Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés and CONICET, Buenos Aires, Argentina
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), California, US
- Trinity College Dublin (TCD), Dublin, Ireland, IE
| | - Katharina Kühne
- Potsdam Embodied Cognition Group, Cognitive Sciences, University of Potsdam, Potsdam, DE
| | - Alex Miklashevsky
- Potsdam Embodied Cognition Group, Cognitive Sciences, University of Potsdam, Potsdam, DE
| | - Elisa Monaco
- Laboratory for Cognitive and Neurological Sciences, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, CH
| | - Emiko Muraki
- Department of Psychology & Hotchkiss Brain Institute, University of Calgary, CA
| | | | | | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, IT
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Dávila G, Torres-Prioris MJ, López-Barroso D, Berthier ML. Turning the Spotlight to Cholinergic Pharmacotherapy of the Human Language System. CNS Drugs 2023; 37:599-637. [PMID: 37341896 PMCID: PMC10374790 DOI: 10.1007/s40263-023-01017-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
Even though language is essential in human communication, research on pharmacological therapies for language deficits in highly prevalent neurodegenerative and vascular brain diseases has received little attention. Emerging scientific evidence suggests that disruption of the cholinergic system may play an essential role in language deficits associated with Alzheimer's disease and vascular cognitive impairment, including post-stroke aphasia. Therefore, current models of cognitive processing are beginning to appraise the implications of the brain modulator acetylcholine in human language functions. Future work should be directed further to analyze the interplay between the cholinergic system and language, focusing on identifying brain regions receiving cholinergic innervation susceptible to modulation with pharmacotherapy to improve affected language domains. The evaluation of language deficits in pharmacological cholinergic trials for Alzheimer's disease and vascular cognitive impairment has thus far been limited to coarse-grained methods. More precise, fine-grained language testing is needed to refine patient selection for pharmacotherapy to detect subtle deficits in the initial phases of cognitive decline. Additionally, noninvasive biomarkers can help identify cholinergic depletion. However, despite the investigation of cholinergic treatment for language deficits in Alzheimer's disease and vascular cognitive impairment, data on its effectiveness are insufficient and controversial. In the case of post-stroke aphasia, cholinergic agents are showing promise, particularly when combined with speech-language therapy to promote trained-dependent neural plasticity. Future research should explore the potential benefits of cholinergic pharmacotherapy in language deficits and investigate optimal strategies for combining these agents with other therapeutic approaches.
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Affiliation(s)
- Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain.
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain.
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
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Wang H, Cai Z, Li S, Zheng J, Xie Y, He Y, Li C, Zheng D. Research hotspots and frontiers of post-stroke aphasia rehabilitation: a bibliometric study and visualization analysis. Front Hum Neurosci 2023; 17:1176923. [PMID: 37250700 PMCID: PMC10213773 DOI: 10.3389/fnhum.2023.1176923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Aphasia is a common complication of stroke and is associated with high morbidity and mortality rates. Rehabilitation plays a crucial role in the comprehensive management of post-stroke aphasia and its consequences. However, bibliometric analysis in the field of post-stroke aphasia rehabilitation is still lacking. This study aimed to comprehensively identify assistance networks, analyze research trends, focus on hot and cutting-edge health topics related to post-stroke aphasia rehabilitation, and inform future research guidelines. Methods The Web of Science Core Collection (WoSCC) electronic database was searched from inception to January 4, 2023 to identify studies related to post-stroke aphasia rehabilitation. Bibliometric analysis and visualization of country, institution, journal, author, reference, and keywords were performed using CiteSpace and VOSviewer software. Results A total of 2,325 papers were included in the analysis, with a progressive increase in the number of articles published each year. The USA was the country with the most publications (809 articles), and the University of Queensland was the institution with the most publications (137 articles). The subject area of post-stroke aphasia rehabilitation is dominated by clinical neurology (882 articles). Aphasiology was the journal with the most publications (254 articles) and the most cited journal (6,893 citations). Worrall L was the most prolific author (51 publications), and Frideriksson J was the most cited author (804 citations). Conclusion By using bibliometrics, we provided a comprehensive review of studies related to post-stroke aphasia rehabilitation. Future research hotspots on topics related to post-stroke aphasia rehabilitation will mainly focus on the plasticity mechanisms of neurolinguistics networks, language function assessment, language rehabilitation modalities, and patients' rehabilitation needs and participation experiences in post-stroke aphasia. This paper provides systematic information that is worth exploring in the future.
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Affiliation(s)
- Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Ziping Cai
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shengjuan Li
- College of Nursing, Jinan University, Guangzhou, China
| | - Jiaxing Zheng
- College of Rehabilitation, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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10
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Berthier ML, Dávila G. Pharmacotherapy for post-stroke aphasia: what are the options? Expert Opin Pharmacother 2023; 24:1221-1228. [PMID: 37263978 DOI: 10.1080/14656566.2023.2221382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Aphasia is a common, long-lasting aftermath of stroke lesions. There is an increased integration of pharmacotherapy as an adjunctive strategy to speech and language therapy (SLT) for post-stroke aphasia (PSA). Nevertheless, more research in pharmacotherapy for acute and chronic PSA is necessary, including the election of drugs that target different neurotransmitter systems and deficits in specific language domains. AREAS COVERED This article updates the role of pharmacotherapy for PSA, focusing the spotlight on some already investigated drugs and candidate agents deserving of future research. Refining the precision of drug election would require using multimodal biomarkers to develop personalized treatment approaches. There is a solid need to devise feasible randomized controlled trials adapted to the particularities of the PSA population. The emergent role of multimodal interventions combining one or two drugs with noninvasive brain stimulation to augment SLT is emphasized. EXPERT OPINION Pharmacotherapy can improve language deficits not fully alleviated by SLT. In addition, the 'drug-only' approach can also be adopted when administering SLT is not possible. The primary goal of pharmacotherapy is reducing the overall aphasia severity, although targeting language-specific deficits (i.e. naming, spoken output) also contributes to improving functional communication. Unfortunately, there is still little information for recommending a drug for specific language deficits.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
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Stockbridge MD, Bunker LD, Hillis AE. Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke. Curr Neurol Neurosci Rep 2022; 22:745-755. [PMID: 36181577 PMCID: PMC9525934 DOI: 10.1007/s11910-022-01231-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Stroke is a common cause of disability in aging adults. A given individual's needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains. RECENT FINDINGS Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients' recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Recent and ongoing trials have increasingly adopted a multidisciplinary nature - augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA.
| | - Lisa D Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
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12
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Common Neuroanatomical Substrate of Cholinergic Pathways and Language-Related Brain Regions as an Explanatory Framework for Evaluating the Efficacy of Cholinergic Pharmacotherapy in Post-Stroke Aphasia: A Review. Brain Sci 2022; 12:brainsci12101273. [PMID: 36291207 PMCID: PMC9599395 DOI: 10.3390/brainsci12101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the relative scarcity of studies focusing on pharmacotherapy in aphasia, there is evidence in the literature indicating that remediation of language disorders via pharmaceutical agents could be a promising aphasia treatment option. Among the various agents used to treat chronic aphasic deficits, cholinergic drugs have provided meaningful results. In the current review, we focused on published reports investigating the impact of acetylcholine on language and other cognitive disturbances. It has been suggested that acetylcholine plays an important role in neuroplasticity and is related to several aspects of cognition, such as memory and attention. Moreover, cholinergic input is diffused to a wide network of cortical areas, which have been associated with language sub-processes. This could be a possible explanation for the positive reported outcomes of cholinergic drugs in aphasia recovery, and specifically in distinct language processes, such as naming and comprehension, as well as overall communication competence. However, evidence with regard to functional alterations in specific brain areas after pharmacotherapy is rather limited. Finally, despite the positive results derived from the relevant studies, cholinergic pharmacotherapy treatment in post-stroke aphasia has not been widely implemented. The present review aims to provide an overview of the existing literature in the common neuroanatomical substrate of cholinergic pathways and language related brain areas as a framework for interpreting the efficacy of cholinergic pharmacotherapy interventions in post-stroke aphasia, following an integrated approach by converging evidence from neuroanatomy, neurophysiology, and neuropsychology.
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Park JG. Update on Stroke Rehabilitation for Non-Motor Impairment. BRAIN & NEUROREHABILITATION 2022; 15:e13. [PMID: 36743206 PMCID: PMC9833475 DOI: 10.12786/bn.2022.15.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Various interventions exist to treat non-motor impairments caused by stroke. Adjuvant treatments such as non-invasive brain stimulation, virtual reality, computer-assisted training, neurostimulation, and biofeedback are being investigated and applied in the areas of cognitive dysfunction, language problems, visual disorders, dysphagia, mood disorders, and post-stroke pain. Most of these treatments have shown efficacy and symptom improvement, but further investigation is required to fully clarify their effects.
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Affiliation(s)
- Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Sang B, Deng S, Zhai J, Hao T, Zhuo B, Qin C, Zhang M, Zhao X, Meng Z. Does acupuncture therapy improve language function of patients with aphasia following ischemic stroke? A systematic review and meta-analysis. NeuroRehabilitation 2022; 51:231-245. [PMID: 35527577 PMCID: PMC9535561 DOI: 10.3233/nre-220007] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aphasia is one of the most common complications in patients with ischemic stroke. Studies have shown that acupuncture can improve the symptoms of aphasia patients. However, the effect of acupuncture on language function in patients with ischemic stroke is still controversial. OBJECTIVE This study aimed to critically assess the efficacy and safety of acupuncture for aphasia following ischemic stroke. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, China National Knowledge Infrastructure, Wanfang Digital Periodicals, and Chinese Science and Technology Periodicals database were searched. All randomized controlled trials (RCTs) that met the criteria were included. RESULTS Meta-analyses showed that mean difference in change of auditory comprehension score (MD = 7.71, 95% CI: 1.83 to 13.59, P = 0.01), spontaneous speech (MD = 2.77, 95% CI: 0.59 to 4.95, P = 0.01), repetition score (MD = 14.48, 95% CI: 11.04 to 17.91, P < 0.00001) and naming score (MD = 14.60, 95% CI: 11.33 to 17.88, P < 0.00001) measured by WAB scale were statistically significant. Subgroup analyses demonstrated that there were statistically significant mean differences in four items of WAB scale in patients with sub-acute stroke, and no statistically significant differences in patients with acute stroke. CONCLUSION The present study suggests that acupuncture may improve the language function of patients with aphasia following ischemic stroke, especially during the sub-acute phase. However, due to insufficient sample sizes and information on the safety, more high-quality RCTs are still needed.
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Affiliation(s)
- Bomo Sang
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jingbo Zhai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ting Hao
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bifang Zhuo
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Qin
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Menglong Zhang
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiaofeng Zhao
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhihong Meng
- Department of Clinical Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review. Neural Plast 2022; 2022:5635596. [PMID: 35494482 PMCID: PMC9050322 DOI: 10.1155/2022/5635596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
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Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia. Brain Sci 2021; 11:brainsci11111508. [PMID: 34827507 PMCID: PMC8615359 DOI: 10.3390/brainsci11111508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023] Open
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Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, Miller E. Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation. J Clin Med 2021; 10:jcm10173778. [PMID: 34501229 PMCID: PMC8432240 DOI: 10.3390/jcm10173778] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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Affiliation(s)
- Natalia Cichon
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
- Correspondence:
| | - Lidia Wlodarczyk
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland;
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Justyna Redlicka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
| | - Leslaw Gorniak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
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DUAL-tDCS Treatment over the Temporo-Parietal Cortex Enhances Writing Skills: First Evidence from Chronic Post-Stroke Aphasia. Life (Basel) 2021; 11:life11040343. [PMID: 33919714 PMCID: PMC8070712 DOI: 10.3390/life11040343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
The learning of writing skills involves the re-engagement of previously established independent procedures. Indeed, the writing deficit an adult may acquire after left hemispheric brain injury is caused by either an impairment to the lexical route, which processes words as a whole, to the sublexical procedure based on phoneme-to-grapheme conversion rules, or to both procedures. To date, several approaches have been proposed for writing disorders, among which, interventions aimed at restoring the sub-lexical procedure were successful in cases of severe agraphia. In a randomized double-blind crossover design, fourteen chronic Italian post-stroke aphasics underwent dual transcranial direct current stimulation (tDCS) (20 min, 2 mA) with anodal and cathodal current simultaneously placed over the left and right temporo-parietal cortex, respectively. Two different conditions were considered: (1) real, and (2) sham, while performing a writing task. Each experimental condition was performed for ten workdays over two weeks. After real stimulation, a greater amelioration in writing with respect to the sham was found. Relevantly, these effects generalized to different language tasks not directly treated. This evidence suggests, for the first time, that dual tDCS associated with training is efficacious for severe agraphia. Our results confirm the critical role of the temporo-parietal cortex in writing skills.
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