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Keser Z, Ikramuddin S, Shekhar S, Feng W. Neuromodulation for Post-Stroke Motor Recovery: a Narrative Review of Invasive and Non‑Invasive Tools. Curr Neurol Neurosci Rep 2023; 23:893-906. [PMID: 38015351 DOI: 10.1007/s11910-023-01319-6] [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] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Stroke remains a leading disabling condition, and many survivors have permanent disability despite acute stroke treatment and subsequent standard-of-care rehabilitation therapies. Adjunctive neuromodulation is an emerging frontier in the field of stroke recovery. In this narrative review, we aim to highlight and summarize various neuromodulation techniques currently being investigated to enhance recovery and reduce impairment in patients with stroke. RECENT FINDINGS For motor recovery, repetitive transcranial magnetic simulation (rTMS) and direct current stimulation (tDCS) have shown promising results in many smaller-scale trials. Still, their efficacy has yet to be proven in large-scale pivotal trials. A promising large-scale study investigating higher dose tDCS combined with constraint movement therapy to enhance motor recovery is currently underway. MRI-guided tDCS studies in subacute and chronic post-stroke aphasia showed promising benefits for picture-naming recovery. rTMS, particularly inhibitory stimulation over the contralesional homolog, could represent a pathway forward in post-stroke motor recovery in the setting of a well-designed and adequately powered clinical trial. Recently evidenced-based guideline actually supported Level A (definite efficacy) for the use of low-frequency rTMS of the primary motor cortex for hand motor recovery in the post-acute stage of stroke based on the meta-analysis result. Adjunctive vagal nerve stimulation has recently received FDA approval to enhance upper limb motor recovery in chronic ischemic stroke with moderate impairment, and progress has been made to implement it in real-world practice. Despite a few small and large-scale studies in epidural stimulation (EDS), further research on the utilization of EDS in post-stroke recovery is needed. Deep brain stimulation or stent-based neuromodulation has yet to be further tested regarding safety and efficacy. Adjunctive neuromodulation to rehabilitation therapy is a promising avenue for promoting post-stroke recovery and decreasing the overall burden of disability. The pipeline for neuromodulation technology remains strong as they span from the preclinical stage to the post-market stage. We are optimistic to see that more neuromodulation tools will be available to stroke survivors in the not-to-distant future.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Salman Ikramuddin
- Department of Neurology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Shashank Shekhar
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA.
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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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Ivanova MV, Pappas I, Inglis B, Pracar AL, Herron TJ, Baldo JV, Kayser AS, D’Esposito M, Dronkers NF. Cerebral perfusion in post-stroke aphasia and its relationship to residual language abilities. Brain Commun 2023; 6:fcad252. [PMID: 38162898 PMCID: PMC10757451 DOI: 10.1093/braincomms/fcad252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024] Open
Abstract
Stroke alters blood flow to the brain resulting in damaged tissue and cell death. Moreover, the disruption of cerebral blood flow (perfusion) can be observed in areas surrounding and distal to the lesion. These structurally preserved but suboptimally perfused regions may also affect recovery. Thus, to better understand aphasia recovery, the relationship between cerebral perfusion and language needs to be systematically examined. In the current study, we aimed to evaluate (i) how stroke affects perfusion outside of lesioned areas in chronic aphasia and (ii) how perfusion in specific cortical areas and perilesional tissue relates to language outcomes in aphasia. We analysed perfusion data from a large sample of participants with chronic aphasia due to left hemisphere stroke (n = 43) and age-matched healthy controls (n = 25). We used anatomically defined regions of interest that covered the frontal, parietal, and temporal areas of the perisylvian cortex in both hemispheres, areas typically known to support language, along with several control regions not implicated in language processing. For the aphasia group, we also looked at three regions of interest in the perilesional tissue. We compared perfusion levels between the two groups and investigated the relationship between perfusion levels and language subtest scores while controlling for demographic and lesion variables. First, we observed that perfusion levels outside the lesioned areas were significantly reduced in frontal and parietal regions in the left hemisphere in people with aphasia compared to the control group, while no differences were observed for the right hemisphere regions. Second, we found that perfusion in the left temporal lobe (and most strongly in the posterior part of both superior and middle temporal gyri) and inferior parietal areas (supramarginal gyrus) was significantly related to residual expressive and receptive language abilities. In contrast, perfusion in the frontal regions did not show such a relationship; no relationship with language was also observed for perfusion levels in control areas and all right hemisphere regions. Third, perilesional perfusion was only marginally related to language production abilities. Cumulatively, the current findings demonstrate that blood flow is reduced beyond the lesion site in chronic aphasia and that hypoperfused neural tissue in critical temporoparietal language areas has a negative impact on behavioural outcomes. These results, using perfusion imaging, underscore the critical and general role that left hemisphere posterior temporal regions play in various expressive and receptive language abilities. Overall, the study highlights the importance of exploring perfusion measures in stroke.
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Affiliation(s)
- Maria V Ivanova
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Ioannis Pappas
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Ben Inglis
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, CA 94720, USA
| | - Alexis L Pracar
- Department of Psychology, University of California, Berkeley, CA 94720, USA
| | - Timothy J Herron
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Juliana V Baldo
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Andrew S Kayser
- Division of Neurology, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Neurology Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Depertment of Neurology, University of California, Davis, CA 95817, USA
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Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restor Neurol Neurosci 2023; 41:129-191. [PMID: 37980575 PMCID: PMC10741339 DOI: 10.3233/rnn-231344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
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Affiliation(s)
| | - Olga Boukrina
- Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, NJ, USA
| | - Xin Ran Li
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fatima Jebahi
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
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Pillay SB, Gross WL, Heffernan J, Book DS, Binder JR. Semantic network activation facilitates oral word reading in chronic aphasia. BRAIN AND LANGUAGE 2022; 233:105164. [PMID: 35933744 PMCID: PMC9948519 DOI: 10.1016/j.bandl.2022.105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/22/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
People with aphasia often show partial impairments on a given task. This trial-to-trial variability offers a potential window into understanding how damaged language networks function. We test the hypothesis that successful word reading in participants with phonological system damage reflects semantic system recruitment. Residual semantic and phonological networks were defined with fMRI in 21 stroke participants with phonological damage using semantic- and rhyme-matching tasks. Participants performed an oral word reading task, and activation was compared between correct and incorrect trials within the semantic and phonological networks. The results showed a significant interaction between hemisphere, network activation, and reading success. Activation in the left hemisphere semantic network was higher when participants successfully read words. Residual phonological regions showed no difference in activation between correct and incorrect trials on the word reading task. The results provide evidence that semantic processing supports successful phonological retrieval in participants with phonological impairment.
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Affiliation(s)
- Sara B Pillay
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
| | - William L Gross
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Joseph Heffernan
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Diane S Book
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Jeffrey R Binder
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Ashaie SA, Engel S, Cherney LR. Timing of transcranial direct current stimulation (tDCS) combined with speech and language therapy (SLT) for aphasia: study protocol for a randomized controlled trial. Trials 2022; 23:668. [PMID: 35978374 PMCID: PMC9386930 DOI: 10.1186/s13063-022-06627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggest that language recovery in aphasia may be improved by pairing speech-language therapy with transcranial direct current stimulation. However, results from many studies have been inconclusive regarding the impact transcranial direct current stimulation may have on language recovery in individuals with aphasia. An important factor that may impact the efficacy of transcranial direct current stimulation is its timing relative to speech-language therapy. Namely, online transcranial direct current stimulation (paired with speech-language therapy) and offline transcranial direct current stimulation (prior to or following speech-language therapy) may have differential effects on language recovery in post-stroke aphasia. Transcranial direct current stimulation provided immediately before speech-language therapy may prime the language system whereas stimulation provided immediately after speech-language therapy may aid in memory consolidation. The main aim of this study is to investigate the differential effects of offline and online transcranial direct stimulation on language recovery (i.e., conversation) in post-stroke aphasia. METHODS/DESIGN The study is a randomized, parallel-assignment, double-blind treatment study. Participants will be randomized to one of four treatment conditions and will participate in 15 treatment sessions. All groups receive speech-language therapy in the form of computer-based script practice. Three groups will receive transcranial direct current stimulation: prior to speech-language therapy, concurrent with speech-language therapy, or following speech-language therapy. One group will receive sham stimulation (speech-language therapy only). We aim to include 12 participants per group (48 total). We will use fMRI-guided neuronavigation to determine placement of transcranial direct stimulation electrodes on participants' left angular gyrus. Participants will be assessed blindly at baseline, immediately post-treatment, and at 4 weeks and 8 weeks following treatment. The primary outcome measure is change in the rate and accuracy of the trained conversation script from baseline to post-treatment. DISCUSSION Results from this study will aid in determining the optimum timing to combine transcranial direct current stimulation with speech-language therapy to facilitate better language outcomes for individuals with aphasia. In addition, effect sizes derived from this study may also inform larger clinical trials investigating the impact of transcranial direct current stimulation on functional communication in individuals with aphasia. TRIAL REGISTRATION ClinicalTrials.gov NCT03773406. December 12, 2018.
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Affiliation(s)
- Sameer A Ashaie
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.,Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Samantha Engel
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA. .,Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
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7
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Matar SJ, Newton C, Sorinola IO, Pavlou M. Transcranial Direct-Current Stimulation as an Adjunct to Verb Network Strengthening Treatment in Post-stroke Chronic Aphasia: A Double-Blinded Randomized Feasibility Study. Front Neurol 2022; 13:722402. [PMID: 35309584 PMCID: PMC8924047 DOI: 10.3389/fneur.2022.722402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Difficulties in discourse production are common in post-stroke chronic aphasia. Previous studies have found that speech and language therapy combined with transcranial direct-current stimulation (tDCS) may improve language skills like naming and enhance aphasia treatment outcomes. However, very few studies have investigated the effect of tDCS when combined with interventions for improving higher level language skills such as the Verb Network Strengthening Treatment (VNeST). Aims This study aimed to determine the feasibility of anodal tDCS as an adjunct to VNeST to improve discourse production in post-stroke chronic aphasia. Methods Six people with post-stroke chronic aphasia took part in this double-blinded randomized feasibility study. Participants were randomly allocated to either the experimental group receiving a 6-week block of once weekly VNeST sessions combined with active tDCS over the left inferior frontal gyrus (LIFG) or a control group that received VNeST with sham stimulation. Feasibility outcomes included screening, eligibility, retention, and completion rates, and adverse events. Preliminary response to intervention was also examined using discourse production, functional communication, quality of life, psychological state, and cognition outcomes. Results Overall 19 individuals were screened and ten met the inclusion criteria. Six individuals provided consent and participated in the study giving a consent rate of 60%. Participant retention and completion rates were 100% and no adverse effects were reported. Exploratory analyses revealed promising changes (i.e., estimated large effect size) in discourse production measures across discourse language tasks and functional communication for the active tDCS group. Conclusions Our results support the feasibility of tDCS as an adjunct to VNeST. Preliminary findings provide motivation for future large-scale studies to better understand the potential of tDCS as a safe and economical tool for enhancing rehabilitation in chronic 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
| | - Caroline Newton
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Isaac O. Sorinola
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's 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
- *Correspondence: Marousa Pavlou
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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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Coemans S, Struys E, Vandenborre D, Wilssens I, Engelborghs S, Paquier P, Tsapkini K, Keulen S. A Systematic Review of Transcranial Direct Current Stimulation in Primary Progressive Aphasia: Methodological Considerations. Front Aging Neurosci 2021; 13:710818. [PMID: 34690737 PMCID: PMC8530184 DOI: 10.3389/fnagi.2021.710818] [Citation(s) in RCA: 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: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of tDCS approaches has been used to investigate the potential of tDCS to improve language outcomes, or slow down the decay of language competences caused by Primary Progressive Aphasia (PPA). The employed stimulation protocols and study designs in PPA are generally speaking similar to those deployed in post-stroke aphasic populations. These two etiologies of aphasia however differ substantially in their pathophysiology, and for both conditions the optimal stimulation paradigm still needs to be established. A systematic review was done and after applying inclusion and exclusion criteria, 15 articles were analyzed focusing on differences and similarities across studies especially focusing on PPA patient characteristics (age, PPA variant, language background), tDCS stimulation protocols (intensity, frequency, combined therapy, electrode configuration) and study design as recent reviews and group outcomes for individual studies suggest tDCS is an effective tool to improve language outcomes, while methodological approach and patient characteristics are mentioned as moderators that may influence treatment effects. We found that studies of tDCS in PPA have clinical and methodological and heterogeneity regarding patient populations, stimulation protocols and study design. While positive group results are usually found irrespective of these differences, the magnitude, duration and generalization of these outcomes differ when comparing stimulation locations, and when results are stratified according to the clinical variant of PPA. We interpret the results of included studies in light of patient characteristics and methodological decisions. Further, we highlight the role neuroimaging can play in study protocols and interpreting results and make recommendations for future work.
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Affiliation(s)
- Silke Coemans
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
| | - Esli Struys
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Reference Center for Biological Markers of Dementia, BIODEM, Institute Born-Bunge, Universiteit Antwerpen, Antwerp, Belgium
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, Antwerp, Belgium.,Department of Translational Neurosciences (TNW), Universiteit Antwerpen, Antwerp, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
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10
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Hong Z, Zheng H, Luo J, Yin M, Ai Y, Deng B, Feng W, Hu X. Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Language Recovery in Poststroke Survivors With Aphasia: An Updated Meta-analysis. Neurorehabil Neural Repair 2021; 35:680-691. [PMID: 34032160 DOI: 10.1177/15459683211011230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on treating poststroke aphasia (PSA) remain inconclusive. We aimed to evaluate the efficacy and safety of LF-rTMS on language function poststroke and determine potential factors that may affect treatment effects. Electronic databases, including MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) concerning the effects of LF-rTMS on language performance poststroke. We adopted fixed- and random-effects models to estimate intervention effects, which were represented by the Hedges' g and 95% CIs. Subgroup analyses regarding several factors potentially influencing the effects of LF-rTMS on language recovery were also conducted. A total of 14 RCTs involving 374 participants were included in the meta-analysis. The pooled analysis showed the positive and significant effects of LF-rTMS on language function, both short-term (Hedges' g = 0.65; P < .05) and long-term (Hedges' g = 0.46; P < .05). Subgroup analyses demonstrated that LF-rTMS for 20 minutes per day over 10 days yielded the largest effect size (Hedges' g = 1.02; P < .05) and that LF-rTMS significantly improved language performance in the chronic stage after stroke (Hedges' g = 0.55; P < .05). Patients with different native languages might have diverse responses to LF-rTMS treatment efficacy. Additionally, there were significant improvements in language subtests, including naming, repetition, comprehension, and writing. Overall, this updated meta-analysis demonstrated that LF-rTMS has significant positive effects on PSA, with moderate treatment effects. It provides additional evidence to support LF-rTMS as a promising complementary therapy to promote language recovery in PSA.
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Affiliation(s)
- Zhongqiu Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baomei Deng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wuwei Feng
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23:183-201. [PMID: 34102754 PMCID: PMC8189855 DOI: 10.5853/jos.2020.05015] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.
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Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye Elizabeth Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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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: 226] [Impact Index Per Article: 75.3] [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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13
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Sheppard SM, Sebastian R. Diagnosing and managing post-stroke aphasia. Expert Rev Neurother 2021; 21:221-234. [PMID: 33231117 PMCID: PMC7880889 DOI: 10.1080/14737175.2020.1855976] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery.
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Affiliation(s)
- Shannon M. Sheppard
- Department of Communication Sciences and Disorder, Chapman University, Irvine, CA, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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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: 16] [Impact Index Per Article: 5.3] [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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15
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Sebastian R, Kim JH, Brenowitz R, Tippett DC, Desmond JE, Celnik PA, Hillis AE. Cerebellar neuromodulation improves naming in post-stroke aphasia. Brain Commun 2020; 2:fcaa179. [PMID: 33241212 PMCID: PMC7677607 DOI: 10.1093/braincomms/fcaa179] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation has been shown to increase the efficiency of language therapy in chronic aphasia; however, to date, an optimal stimulation site has not been identified. We investigated whether neuromodulation of the right cerebellum can improve naming skills in chronic aphasia. Using a randomized, double-blind, sham-controlled, within-subject crossover study design, participants received anodal cerebellar stimulation (n = 12) or cathodal cerebellar stimulation (n = 12) + computerized aphasia therapy then sham + computerized aphasia therapy, or the opposite order. There was no significant effect of treatment (cerebellar stimulation versus sham) for trained naming. However, there was a significant order x treatment interaction, indicating that cerebellar stimulation was more effective than sham immediately post-treatment for participants who received cerebellar stimulation in the first phase. There was a significant effect of treatment (cerebellar stimulation versus sham) for untrained naming immediately post-treatment and the significant improvement in untrained naming was maintained at two months post-treatment. Greater gains in naming (relative to sham) were noted for participants receiving cathodal stimulation for both trained and untrained items. Thus, our study provides evidence that repetitive cerebellar transcranial direct stimulation combined with computerized aphasia treatment can improve picture naming in chronic post-stroke aphasia. These findings suggest that the right cerebellum might be an optimal stimulation site for aphasia rehabilitation and this could be an answer to handle heterogeneous participants who vary in their size and site of left hemisphere lesions.
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Affiliation(s)
- Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Brenowitz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna C Tippett
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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16
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Tscherpel C, Grefkes C. Funktionserholung nach Schlaganfall und die therapeutische Rolle der nicht-invasiven Hirnstimulation. KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1272-9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungIm Bereich der non-invasiven Hirnstimulation stellen die transkranielle Magnetstimulation (engl. transcranial magnetic stimulation, TMS) sowie die transkranielle Gleichstromstimulation (engl. transcranial direct current stimulation, tDCS) bis heute die wichtigsten Techniken zur Modulation kortikaler Erregbarkeit dar. Beide Verfahren induzieren Nacheffekte, welche die Zeit der reinen Stimulation überdauern, und ebnen damit den Weg für ihren therapeutischen Einsatz beim Schlaganfall. In diesem Übersichtsartikel diskutieren wir die aktuelle Datenlage TMS- und tDCS-vermittelter Therapien für die häufigsten schlaganfallbedingten Defizite wie Hemiparese, Aphasie und Neglect. Darüber hinaus adressieren wir mögliche Einschränkungen der gegenwärtigen Ansätze und zeigen Ansatzpunkte auf, um Neuromodulation nach Schlaganfall effektiver zu gestalten und damit das Outcome der Patienten zu verbessern.
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Affiliation(s)
- Caroline Tscherpel
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
| | - Christian Grefkes
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln
- Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich
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17
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Fabian R, Bunker L, Hillis AE. Is Aphasia Treatment Beneficial for the Elderly? A Review of Recent Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:478-492. [PMID: 33777504 DOI: 10.1007/s40141-020-00287-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose We review recent literature regarding aphasia therapy in the elderly. Relevant articles from the last 5 years were identified to determine whether or not there is evidence to support that various therapeutic approaches can have a positive effect on post-stroke aphasia in the elderly. Recent findings There were no studies examining the effects of aphasia therapy specifically in the elderly within the timeframe searched. Therefore, we briefly summarize findings from 50 relevant studies that included large proportions of participants with post-stroke aphasia above the age of 65. A variety of behavioral and neuromodulation therapies are reported. Summary We found ample evidence suggesting that a variety of behavioral and neuromodulatory therapeutic approaches can benefit elderly individuals with post-stroke aphasia.
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Affiliation(s)
- Rachel Fabian
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Argye E Hillis
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine.,Department of Neurology, Johns Hopkins University School of Medicine
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18
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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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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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21
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Jordan KM, Keshavan A, Caverzasi E, Osorio J, Papinutto N, Amirbekian B, Berger MS, Henry RG. Longitudinal Disconnection Tractograms to Investigate the Functional Consequences of White Matter Damage: An Automated Pipeline. J Neuroimaging 2020; 30:443-457. [PMID: 32436352 DOI: 10.1111/jon.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurosurgical resection is one of the few opportunities researchers have to image the human brain pre- and postfocal damage. A major challenge associated with brains undergoing surgical resection is that they often do not fit brain templates most image-processing methodologies are based on. Manual intervention is required to reconcile the pathology, requiring time investment and introducing reproducibility concerns, and extreme cases must be excluded. METHODS We propose an automatic longitudinal pipeline based on High Angular Resolution Diffusion Imaging acquisitions to facilitate a Pathway Lesion Symptom Mapping analysis relating focal white matter injury to functional deficits. This two-part approach includes (i) automatic segmentation of focal white matter injury from anisotropic power differences, and (ii) modeling disconnection using tractography on the single-subject level, which specifically identifies the disconnections associated with focal white matter damage. RESULTS The advantages of this approach stem from (1) objective and automatic lesion segmentation and tractogram generation, (2) objective and precise segmentation of affected tissue likely to be associated with damage to long-range white matter pathways (defined by anisotropic power), (3) good performance even in the cases of anatomical distortions by use of nonlinear tensor-based registration, which aligns images using an approach sensitive to white matter microstructure. CONCLUSIONS Mapping a system as variable and complex as the human brain requires sample sizes much larger than the current technology can support. This pipeline can be used to execute large-scale, sufficiently powered analyses by meeting the need for an automatic approach to objectively quantify white matter disconnection.
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Affiliation(s)
- Kesshi M Jordan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Anisha Keshavan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, CA
| | - Joseph Osorio
- Division of Neurosurgery, Department of Surgery, University of California, San Diego, CA
| | - Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA
| | - Bagrat Amirbekian
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Mitchel S Berger
- Department of Neurosurgery, University of California, San Francisco, CA
| | - Roland G Henry
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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22
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Belopasova AV, Dobrynina LA, Kadykov AS, Berdnikovich ES, Bergelson TM, Tsypushtanova MM. [Noninvasive brain stimulation in the rehabilitation of patients with post-stroke aphasia]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:23-28. [PMID: 32307426 DOI: 10.17116/jnevro202012003223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, non-invasive brain stimulation, in particular transcranial stimulation by direct electric current (TES), has been increasingly included in the array of methods used for rehabilitation of patients with post-stroke impairments (motor, speech, cognitive). Development of stimulation protocols with determination of the zones of exposure, as well as better understanding of the patterns of restoration of functional systems, became possible due to basic research using functional MRI paradigm. However, the complexity of the organization of the speech system, the variety of forms of aphasia that occur when it is damaged, the individual variability of neuroplastic processes, motivated a search for optimal stimulation protocols that contribute to the personification of the rehabilitation process. Portability, low cost of equipment, a good safety and tolerance profile, as well as a proven effect on neuroplasticity processes, are the undoubted advantages of TES-therapy. There is reason to believe that further study and clinical testing of this technique will turn it into the promising tool for enhancing the effectiveness of classical speech therapy approaches in patients with post-stroke aphasia.
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Affiliation(s)
| | | | - A S Kadykov
- Research Center of Neurology, Moscow, Russia
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23
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Abstract
Purpose of Review This paper aims to review non-invasive brain stimulation (NIBS) methods to augment speech and language therapy (SLT) for patients with post-stroke aphasia. Recent Findings In the past five years there have been more than 30 published studies assessing the effect of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) for improving aphasia in people who have had a stroke. Different approaches to NIBS treatment have been used in post-stroke aphasia treatment including different stimulation locations, stimulation intensity, number of treatment sessions, outcome measures, type of aphasia treatment, and time post-stroke. Summary This review of NIBS for post-stroke aphasia shows that both tDCS and TMS can be beneficial for improving speech and language outcomes for patients with stroke. Prior to translating NIBS to clinical practice, further studies are needed to determine optimal tDCS and TMS parameters as well as the mechanisms underlying tDCS and TMS treatment outcomes.
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24
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Marangolo P. The potential effects of transcranial direct current stimulation (tDCS) on language functioning: Combining neuromodulation and behavioral intervention in aphasia. Neurosci Lett 2020; 719:133329. [DOI: 10.1016/j.neulet.2017.12.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 02/08/2023]
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25
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Pisano F, Marangolo P. Looking at ancillary systems for verb recovery: Evidence from non-invasive brain stimulation. Brain Cogn 2020; 139:105515. [PMID: 31902738 DOI: 10.1016/j.bandc.2019.105515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]
Abstract
Several behavioural and neuroimaging studies have suggested that the language function is not restricted into the left areas but it involves regions not predicted by the classical language model. Accordingly, the Embodied Cognition theory postulates a close interaction between the language and the motor system. Indeed, it has been shown that non-invasive brain stimulation (NIBS) is effective for language recovery also when applied over sensorimotor regions, such as the motor cortex, the cerebellum and the spinal cord. We will review a series of NIBS studies in post-stroke aphasic people aimed to assess the impact of NIBS on verb recovery. We first present results which, following the classical assumption of the Broca's area as the key region for verb processing, have shown that the modulation over this area is efficacious for verb improvement. Then, we will present experiments which, according to Embodied Cognition, have directly investigated through NIBS the role of different sensorimotor regions in enhancing verb production. Since verbs play a crucial role for sentence construction which are most often impaired in the aphasic population, we believe that these results have important clinical implications. Indeed, they address the possibility that different structures might support verb processing.
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Affiliation(s)
- F Pisano
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy; IRCCS, Fondazione Santa Lucia, Rome, Italy
| | - P Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy; IRCCS, Fondazione Santa Lucia, Rome, Italy.
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26
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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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27
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Affiliation(s)
- Shauna Berube
- From the Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E Hillis
- From the Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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28
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Woodhead ZVJ, Kerry SJ, Aguilar OM, Ong YH, Hogan JS, Pappa K, Leff AP, Crinion JT. Randomized trial of iReadMore word reading training and brain stimulation in central alexia. Brain 2019; 141:2127-2141. [PMID: 29912350 PMCID: PMC6118228 DOI: 10.1093/brain/awy138] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
Central alexia is an acquired reading disorder co-occurring with a generalized language deficit (aphasia). We tested the impact of a novel training app, ‘iReadMore’, and anodal transcranial direct current stimulation of the left inferior frontal gyrus, on word reading ability in central alexia. The trial was registered at www.clinicaltrials.gov (NCT02062619). Twenty-one chronic stroke patients with central alexia participated. A baseline-controlled, repeated-measures, crossover design was used. Participants completed two 4-week blocks of iReadMore training, one with anodal stimulation and one with sham stimulation (order counterbalanced between participants). Each block comprised 34 h of iReadMore training and 11 stimulation sessions. Outcome measures were assessed before, between and after the two blocks. The primary outcome measures were reading ability for trained and untrained words. Secondary outcome measures included semantic word matching, sentence reading, text reading and a self-report measure. iReadMore training resulted in an 8.7% improvement in reading accuracy for trained words (95% confidence interval 6.0 to 11.4; Cohen’s d = 1.38) but did not generalize to untrained words. Reaction times also improved. Reading accuracy gains were still significant (but reduced) 3 months after training cessation. Anodal transcranial direct current stimulation (compared to sham), delivered concurrently with iReadMore, resulted in a 2.6% (95% confidence interval −0.1 to 5.3; d = 0.41) facilitation for reading accuracy, both for trained and untrained words. iReadMore also improved performance on the semantic word-matching test. There was a non-significant trend towards improved self-reported reading ability. However, no significant changes were seen at the sentence or text reading level. In summary, iReadMore training in post-stroke central alexia improved reading ability for trained words, with good maintenance of the therapy effect. Anodal stimulation resulted in a small facilitation (d = 0.41) of learning and also generalized to untrained items.
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Affiliation(s)
- Zoe V J Woodhead
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK.,Department of Experimental Psychology, University of Oxford, UK
| | - Sheila J Kerry
- Institute of Cognitive Neuroscience, University College London, UK
| | - Oscar M Aguilar
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, UK.,Facultad de Psicología, Pontificia Universidad Javeriana, Colombia
| | - Yean-Hoon Ong
- Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - John S Hogan
- Experimental Psychology, University College London, UK
| | - Katerina Pappa
- Institute of Cognitive Neuroscience, University College London, UK
| | - Alex P Leff
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK.,Institute of Cognitive Neuroscience, University College London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, UK
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29
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Akinina Y, Dragoy O, Ivanova MV, Iskra EV, Soloukhina OA, Petryshevsky AG, Fedinа ON, Turken AU, Shklovsky VM, Dronkers NF. Grey and white matter substrates of action naming. Neuropsychologia 2019; 131:249-265. [PMID: 31129278 DOI: 10.1016/j.neuropsychologia.2019.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022]
Abstract
Despite a persistent interest in verb processing, data on the neural underpinnings of verb retrieval are fragmentary. The present study is the first to analyze the contributions of both grey and white matter damage affecting verb retrieval through action naming in stroke. We used voxel-based lesion-symptom mapping (VLSM) with an action naming task in 40 left-hemisphere stroke patients. Within the grey matter, we revealed the critical involvement of the left precentral and inferior frontal gyri, insula, and parts of basal ganglia. An overlay of white matter tract probability masks on the VLSM lesion map revealed involvement of left-hemisphere long and short association tracts with terminations in the frontal areas; and several projection tracts. The involvement of these structures is interpreted in the light of existing picture naming models, semantic control processes, and the embodiment cognition framework. Our results stress the importance of both cortico-cortical and cortico-subcortical networks of language processing.
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Affiliation(s)
- Yu Akinina
- National Research University Higher School of Economics, Center for Language and Brain, 21/4 Staraya Basmannaya Street, Office 510, 105066, Moscow, Russia; University of Groningen, Graduate School for the Humanities, P.O. Box 716, NL-9700, AS Groningen, Groningen, the Netherlands.
| | - O Dragoy
- National Research University Higher School of Economics, Center for Language and Brain, 21/4 Staraya Basmannaya Street, Office 510, 105066, Moscow, Russia; Federal Center for Cerebrovascular Pathology and Stroke, Department of Medical Rehabilitation, 1/10 Ostrovityanova Street, 117342, Moscow, Russia
| | - M V Ivanova
- National Research University Higher School of Economics, Center for Language and Brain, 21/4 Staraya Basmannaya Street, Office 510, 105066, Moscow, Russia; University of California, Berkeley, Dept. of Psychology, 2121 Berkeley Way, 94704, Berkeley, CA, USA; Center for Aphasia and Related Disorders, VA Northern California Health Care System, 150 Muir Road 126R, 94553, Martinez, CA, USA
| | - E V Iskra
- National Research University Higher School of Economics, Center for Language and Brain, 21/4 Staraya Basmannaya Street, Office 510, 105066, Moscow, Russia; Center for Speech Pathology and Neurorehabilitation, 20 Nikoloyamskaya Street, 109240, Moscow, Russia
| | - O A Soloukhina
- National Research University Higher School of Economics, Center for Language and Brain, 21/4 Staraya Basmannaya Street, Office 510, 105066, Moscow, Russia
| | - A G Petryshevsky
- Center for Speech Pathology and Neurorehabilitation, 20 Nikoloyamskaya Street, 109240, Moscow, Russia
| | - O N Fedinа
- Center for Speech Pathology and Neurorehabilitation, 20 Nikoloyamskaya Street, 109240, Moscow, Russia; Medicine and Nuclear Technology Ltd., 1/133 Akademika Kurchatova Street, 123182, Moscow, Russia
| | - A U Turken
- Center for Aphasia and Related Disorders, VA Northern California Health Care System, 150 Muir Road 126R, 94553, Martinez, CA, USA
| | - V M Shklovsky
- Center for Speech Pathology and Neurorehabilitation, 20 Nikoloyamskaya Street, 109240, Moscow, Russia
| | - N F Dronkers
- University of California, Berkeley, Dept. of Psychology, 2121 Berkeley Way, 94704, Berkeley, CA, USA; Center for Aphasia and Related Disorders, VA Northern California Health Care System, 150 Muir Road 126R, 94553, Martinez, CA, USA; University of California, Davis, Dept. of Neurology, Sacramento, CA, USA
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30
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Formisano R, Toppi J, Risetti M, Aloisi M, Contrada M, Ciurli PM, Falletta Caravasso C, Luccichenti G, Astolfi L, Cincotti F, Mattia D. Language-Related Brain Potentials in Patients With Disorders of Consciousness: A Follow-up Study to Detect “Covert” Language Disorders. Neurorehabil Neural Repair 2019; 33:513-522. [DOI: 10.1177/1545968319846123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Language disorders may occur in patients with disorders of consciousness (DoCs), and they could interfere with the behavioral assessment of consciousness and responsiveness. Objective. In this study, we retrospectively explored whether ERP N400 was eventually associated with the presence of aphasia diagnosed in those patients who had evolved into Exit-Minimally Conscious State (E-MCS) at the clinical follow-up. Methods. In this retrospective cohort study, the ERPs elicited by an auditory sentences task were retrospectively examined in a sample of 15 DoC patients diagnosed according to the Coma Recovery Scale–Revised (CRS-R). All these 15 DoC patients underwent a (at least) 1-year clinical follow-up, which included a neuropsychological evaluation to assess language function among other cognitive functions. Ten healthy individuals also underwent the same paradigm to investigate the variability of ERPs characteristics. Results. The N400 ERP component with centroparietal topography was found in 9 of 10 healthy controls in response to the ill-formed sentences. Analysis of patients’ data revealed that (1) a significant N400 component could be detected in 64% (9 of 14 patients) of the DoC patients regardless of the type of DoC; (2) no significant N400 ERP component was retrospectively detected in those E-MCS patients who showed aphasia at the follow-up; and (3) the presence/absence of the N400-ERP component was consistent with the brain lesion side and significantly predict the recovery. Conclusion. These preliminary findings indicate that the absence of N400 was significantly associated with the presence of aphasia diagnosed at the clinical follow-up in E-MCS patients.
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Affiliation(s)
| | - Jlenia Toppi
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Dept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | - Laura Astolfi
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Dept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Febo Cincotti
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Dept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
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31
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Feil S, Eisenhut P, Strakeljahn F, Müller S, Nauer C, Bansi J, Weber S, Liebs A, Lefaucheur JP, Kesselring J, Gonzenbach R, Mylius V. Left Shifting of Language Related Activity Induced by Bihemispheric tDCS in Postacute Aphasia Following Stroke. Front Neurosci 2019; 13:295. [PMID: 31105510 PMCID: PMC6498872 DOI: 10.3389/fnins.2019.00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 12/02/2022] Open
Abstract
Both anodal transcranial direct current stimulation (tDCS) of the left IFG and cathodal stimulation of the right IFG were shown to improve rehabilitation of stroke patients with Broca’s aphasia. The study aimed at assessing the impact of a bihemispheric IFG stimulation compared to sham on postacute non-fluent aphasia. Twelve patients with non-fluent aphasia were included at least 4 weeks following cerebral stroke. Ten daily sessions of 2 mA bihemispheric verum or sham tDCS (anode on left IFG and cathode on right IFG) were performed concomitantly with individual language therapy in a double-blinded randomized controlled study with parallel group design. Language functions [i.e., communication (ANELT), picture naming and the Aachen aphasia test (AAT)] were assessed up to 1 month following tDCS. The picture naming task significantly improved (increased number of nouns) at the end of the tDCS procedure in the verum but not sham group. Improvements in the picture naming task and the communication task of the AAT at 4 weeks after tDCS procedure were only seen in the verum group. In patients with postacute cerebral stroke, repeated sessions of tDCS applied on both IFG concomitantly with language therapy were able to induce immediate effects on picture naming presumably due to an early left shift of language-associated function that maintained for 4 weeks. Effects on clinically relevant communicative abilities are likely.
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Affiliation(s)
- Sarah Feil
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.,Schweizer Hochschule für Logopädie Rorschach, Rorschach, Switzerland
| | - Peter Eisenhut
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Frauke Strakeljahn
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Sarah Müller
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Claude Nauer
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Jens Bansi
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Stefan Weber
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Alexandra Liebs
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Jean-Pascal Lefaucheur
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri-Mondor AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Jürg Kesselring
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.,Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
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32
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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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Abstract
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery. In this review, we discuss the recent evidence of the contribution of infarct location to patient management decisions and functional outcomes after acute ischemic stroke.
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Affiliation(s)
- Mark R Etherton
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia S Rost
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ona Wu
- 1 Harvard Medical School, Boston, MA, USA.,3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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34
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Shuster LI. Considerations for the Use of Neuroimaging Technologies for Predicting Recovery of Speech and Language in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:291-305. [PMID: 29497745 DOI: 10.1044/2018_ajslp-16-0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The number of research articles aimed at identifying neuroimaging biomarkers for predicting recovery from aphasia continues to grow. Although the clinical use of these biomarkers to determine prognosis has been proposed, there has been little discussion of how this would be accomplished. This is an important issue because the best translational science occurs when translation is considered early in the research process. The purpose of this clinical focus article is to present a framework to guide the discussion of how neuroimaging biomarkers for recovery from aphasia could be implemented clinically. METHOD The genomics literature reveals that implementing genetic testing in the real-world poses both opportunities and challenges. There is much similarity between these opportunities and challenges and those related to implementing neuroimaging testing to predict recovery in aphasia. Therefore, the Center for Disease Control's model list of questions aimed at guiding the review of genetic testing has been adapted to guide the discussion of using neuroimaging biomarkers as predictors of recovery in aphasia. CONCLUSION The adapted model list presented here is a first and useful step toward initiating a discussion of how neuroimaging biomarkers of recovery could be employed clinically to provide improved quality of care for individuals with aphasia.
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Affiliation(s)
- Linda I Shuster
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo
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35
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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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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: 9] [Impact Index Per Article: 1.1] [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: 984] [Impact Index Per Article: 123.0] [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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Grey Matter Density Predicts the Improvement of Naming Abilities After tDCS Intervention in Agrammatic Variant of Primary Progressive Aphasia. Brain Topogr 2016; 29:738-51. [DOI: 10.1007/s10548-016-0494-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/07/2016] [Indexed: 12/22/2022]
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Structural Image Analysis of the Brain in Neuropsychology Using Magnetic Resonance Imaging (MRI) Techniques. Neuropsychol Rev 2015; 25:224-49. [PMID: 26280751 DOI: 10.1007/s11065-015-9290-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/16/2015] [Indexed: 12/11/2022]
Abstract
Magnetic resonance imaging (MRI) of the brain provides exceptional image quality for visualization and neuroanatomical classification of brain structure. A variety of image analysis techniques provide both qualitative as well as quantitative methods to relate brain structure with neuropsychological outcome and are reviewed herein. Of particular importance are more automated methods that permit analysis of a broad spectrum of anatomical measures including volume, thickness and shape. The challenge for neuropsychology is which metric to use, for which disorder and the timing of when image analysis methods are applied to assess brain structure and pathology. A basic overview is provided as to the anatomical and pathoanatomical relations of different MRI sequences in assessing normal and abnormal findings. Some interpretive guidelines are offered including factors related to similarity and symmetry of typical brain development along with size-normalcy features of brain anatomy related to function. The review concludes with a detailed example of various quantitative techniques applied to analyzing brain structure for neuropsychological outcome studies in traumatic brain injury.
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Wu O, Cloonan L, Mocking SJT, Bouts MJRJ, Copen WA, Cougo-Pinto PT, Fitzpatrick K, Kanakis A, Schaefer PW, Rosand J, Furie KL, Rost NS. Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes. Stroke 2015. [PMID: 26199314 DOI: 10.1161/strokeaha.115.009643] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes. METHODS Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity. RESULTS Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus. CONCLUSIONS Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies.
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Affiliation(s)
- Ona Wu
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.).
| | - Lisa Cloonan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Steven J T Mocking
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Mark J R J Bouts
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - William A Copen
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Pedro T Cougo-Pinto
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Kaitlin Fitzpatrick
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Allison Kanakis
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Pamela W Schaefer
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Jonathan Rosand
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Karen L Furie
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
| | - Natalia S Rost
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Charlestown, MA (O.W., S.J.T.M., M.J.R.J.B.); JP Kistler Stroke Research Center, Department of Neurology (L.C., P.T.C.-P., K.F., A.K., J.R., K.L.F., N.S.R.), Division of Neuroradiology, Department of Radiology (W.A.C., P.W.S.), Division of Neurocritical Care and Emergency Neurology (J.R.), and Center for Human Genetic Research (J.R.), MGH, Boston, MA; and Department of Neurology, Brown University, Providence, RI (K.L.F.)
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