Anomia training and brain stimulation in chronic aphasia

IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Neuropsychological Rehabilitation (Impact Factor: 1.96). 10/2011; 21(5):717-41. DOI: 10.1080/09602011.2011.621275
Source: PubMed


Recent studies have reported enhanced performance on language tasks induced by non-invasive brain stimulation, i.e., repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS), in patients with aphasia due to stroke or Alzheimer's disease (AD). The first part of this article reviews brain stimulation studies related to language recovery in aphasic patients. The second part reports results from a pilot study with three chronic stroke patients who had non-fluent aphasia, where real or placebo rTMS was immediately followed by 25 minutes of individualised speech therapy. Real rTMS consisted of high-frequency rTMS over the left dorsolateral prefrontal cortex (BA 8/9) for 25 minutes. Each patient underwent a total of four weeks of intervention. P1 underwent four weeks of real rTMS (5 days/week) where individualised speech therapy was provided for 25 minutes immediately following each rTMS session. P2 and P3 each underwent two weeks of placebo rTMS, followed immediately by individualised speech therapy; then two weeks of real rTMS, followed immediately by individualised speech therapy. Assessments took place at 2, 4, 12, 24 and 48 weeks post-entry/baseline testing. Relative to entry/baseline testing, a significant improvement in object naming was observed at all testing times, from two weeks post-intervention in real rTMS plus speech therapy, or placebo rTMS plus speech therapy. Our findings suggest beneficial effects of targeted behavioural training in combination with brain stimulation in chronic aphasic patients. However, further work is required in order to verify whether optimal combination parameters (rTMS alone or speech therapy alone) and length of rTMS treatment may be found.

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    • "led to an improvement of the cognitive language ability (Miniussi et al., 2008; Cotelli et al., 2011). One final comment regards the fact that traditional standardized language tests failed to capture the significant posttherapy effect that was evident during the descriptions of the videoclips. "
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    ABSTRACT: In this study, we investigated the combined effect of transcranial direct current stimulation (tDCS) and an intensive Conversational therapy treatment on discourse skills in 12 persons with chronic aphasia. Six short video clips depicting everyday life contexts were prepared. Three videoclips were used to elicit spontaneous conversation during treatment. The remaining three were presented only before and after the therapy. Participants were prompted to talk about the contents of each videoclip while stimulated with tDCS (20 min 1 mA) over the left hemisphere in three conditions: anodic tDCS over the Broca's area, anodic tDCS over the Wernicke's area, and a sham condition. Each experimental condition was performed for 10 consecutive daily sessions with 14 days of intersession interval. After stimulation over Broca's area, the participants produced more Content Units, verbs and sentences than in the remaining two conditions. Importantly, this improvement was still detectable 1 month after the end of treatment and its effects were generalized also to the three videoclips that had been administered at the beginning and at the end of the therapy sessions. In conclusion, anodic tDCS applied over the left Broca's area together with an intensive "Conversational Therapy" treatment improves informative speech in persons with chronic aphasia. We believe that positive tDCS effects may be further extended to other language domains, such as the recovery of speech production.
    Full-text · Article · Sep 2013 · Frontiers in Human Neuroscience
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    • "In addition to the case studies noted above that have used inhibitory rTMS to the contralesioned hemisphere to improve language post-stroke, several case studies have recently provided evidence that high frequency rTMS applied to the lesioned hemisphere may reactivate brain regions ipsilateral to the lesion. Cotelli et al. (2011) examined the effects of 20 Hz rTMS to the left dorsolateral prefrontal cortex on the language abilities of three individuals with chronic non-fl uent aphasia subsequent to left hemisphere lesions. All three cases also concurrently received individualized speech-language therapy to facilitate naming as well as an articulatory suppression task. "
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    ABSTRACT: There is a growing body of evidence to support the use of non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for the treatment of acquired speech and language disorders. The aim of the present paper is to review evidence to support the use of these procedures in the treatment of aphasia and dysarthria. Both TMS and tDCS are described in terms of their underlying principles and biophysics and their relative advantages and disadvantages for rehabilitation of acquired neurogenic communication disorders. Several studies have documented positive effects of inhibitory repetitive TMS (rTMS) to right Broca's area homologue on language recovery in non-fluent aphasia post-stroke. Improved language outcomes subsequent to high frequency rTMS applied to the lesioned hemisphere have also been documented. Similarly, therapeutic benefits have also been reported following tDCS, although the findings are less consistent than is the case with rTMS. Improved articulatory function and speech intelligibility has been noted in response to stimulation with excitatory rTMS in Parkinson's disease. It is suggested that the use of brain stimulation techniques in combination with more traditional therapies may represent the most innovative future approach to the treatment of acquired communication disorders.
    Full-text · Article · Dec 2012 · International Journal of Speech-Language Pathology
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    • "Since the introduction of rTMS, it has become evident that the modulatory effects of cortical stimulation may outlast the immediate stimulation period, with effects from repeated sessions lasting for days and even weeks. Along these lines, the use of tDCS has also been shown to have potential for the treatment of neurological diseases (Miniussi et al., 2008; Boggio et al., 2011b; Cotelli et al., 2011b; Miniussi and Rossini, 2011; Miniussi and Vallar, 2011). Non-invasive brain stimulation techniques for modulating cortical activity include TMS (Wassermann et al., 2008a) and tDCS (Nitsche et al., 2008). "
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    ABSTRACT: Non-pharmacological intervention of memory difficulties in healthy older adults, as well as those with brain damage and neurodegenerative disorders, has gained much attention in recent years. The two main reasons that explain this growing interest in memory rehabilitation are the limited efficacy of current drug therapies and the plasticity of the human central nervous and the discovery that during aging, the connections in the brain are not fixed but retain the capacity to change with learning. Moreover, several studies have reported enhanced cognitive performance in patients with neurological disease, following non-invasive brain stimulation [i.e., repetitive transcranial magnetic stimulation and transcranial direct current stimulation to specific cortical areas]. The present review provides an overview of memory rehabilitation in individuals with mild cognitive impairment and in patients with Alzheimer's disease with particular regard to cognitive rehabilitation interventions focused on memory and non-invasive brain stimulation. Reviewed data suggest that in patients with memory deficits, memory intervention therapy could lead to performance improvements in memory, nevertheless further studies need to be conducted in order to establish the real value of this approach.
    Full-text · Article · Mar 2012 · Frontiers in Human Neuroscience
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