A feasibility study of combined intermittent theta burst stimulation and modified constraint-induced aphasia therapy in chronic post-stroke aphasia

Szaflarski, Jerzy P.; Griffis, Joseph C.; Vannest, Jennifer; Allendorfer, Jane B.; Nenert, Rodolphe; Amara, Amy W.; Sung, Victor; Walker, Harrison C.; Martin, Amber N.; Mark, Victor W.; Zhou, Xingwei

doi:10.3233/rnn-180812

Cited by 21 publications

(44 citation statements)

References 69 publications

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“…Studies have indicated that non-invasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) may promote more effective language recovery after stroke [ 3 – 6 ]. One prevailing concept is that diminished transcallosal inhibition of the non-dominant right hemisphere following left middle cerebral artery stroke negatively affects the potential of left-hemispheric dominant language centers to recover function [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Functional Magnetic Resonance Imaging of Language Following Constraint-Induced Aphasia Therapy Primed with Intermittent Theta Burst Stimulation in 13 Patients with Post-Stroke Aphasia

et al. 2021

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Background Aphasia is a debilitating consequence of stroke. This study aimed to investigate the role of functional magnetic resonance imaging (fMRI) activation changes during overt language tasks in promoting language improvements following constraint-induced aphasia therapy (CIAT) primed with intermittent theta burst stimulation (iTBS) in 13 patients with aphasia following ischemic stroke. Material/Methods Participants with post-stroke aphasia participated in CIAT primed with iTBS on 10 consecutive weekdays. They also underwent language testing and fMRI while performing overt language tasks at baseline (N=13), immediately post-treatment (N=13), and after 3 months (N=12). Outcome measures were compared between time points, and relationships between changes in language ability and fMRI activation were examined. Results We observed improvements in naming (p<0.001), aphasia symptoms (p=0.038), apraxia of speech symptoms (p=0.040), perception of everyday communicative ability (p=0.001), and the number of spoken words produced during fMRI (p=0.028). Pre- to post-treatment change in naming was negatively correlated with change in right postcentral gyrus activation related to noun-verb associations (rho=−0.554, p=0.0497). Change in aphasia symptoms from immediately after to 3 months post-treatment was negatively correlated with change in bilateral supplementary motor area activation related to verbal encoding (rho=−0.790, p=0.0022). Conclusions Aphasia improvements coupled with fMRI activation changes over time provide support for treatment-induced neuroplasticity with CIAT primed with iTBS. However, a larger randomized sham-controlled study is warranted to confirm our findings and further our understanding of how iTBS can potentiate beneficial effects of language therapy in post-stroke aphasia.

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Section: Introductionmentioning

confidence: 99%

Functional Magnetic Resonance Imaging of Language Following Constraint-Induced Aphasia Therapy Primed with Intermittent Theta Burst Stimulation in 13 Patients with Post-Stroke Aphasia

et al. 2021

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“…Based on these considerations, it is reasonable to assume that activating preserved neural pathways in left temporal lobe by means of non-invasive brain stimulation, in combination with conventional speech therapy, may help the rehabilitation of poststroke aphasia. A few preliminary TMS and transcranial direct current stimulation approaches targeting the left temporal region in chronic aphasic patients showed indeed significant improvement in language abilities (18,(64)(65)(66). An alternative promising approach to foster audiomotor integration ability, tested so far only in patients with disorder of consciousness due to severe brain injury, consisted in pairing auditory with transcranial magnetic stimuli on the primary motor area, using the stimulation paradigm known as paired associative stimulation, which induces associative LTP or LTD-like neuronal plasticity (67).…”

Section: Discussionmentioning

confidence: 99%

“…Ten Hertz rTMS over to the lesional inferior frontal gyrus improved repetition and naming tasks in a chronic stroke patient with non-fluent aphasia (16). More recently, iTBS was applied to the fMRI determined residual left frontotemporal language-responsive regions in chronic stroke patients suffering from different types of aphasia; an improvement in language performances correlated with increased activation of the stimulated regions (17,18).…”

Section: Introductionmentioning

confidence: 99%

Facilitation of Auditory Comprehension After Theta Burst Stimulation of Wernicke's Area in Stroke Patients: A Pilot Study

Versace¹,

Schwenker

Langthaler

et al. 2020

Front. Neurol.

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Introduction: Single-pulse transcranial magnetic stimulation (TMS) and high-frequency repetitive TMS (rTMS) over Wernicke's area were found to facilitate language functions in right-handed healthy subjects. We aimed at investigating the effects of excitatory rTMS, given as intermittent theta burst stimulation (iTBS) over left Wernicke's area, on auditory comprehension in patients suffering from fluent aphasia after stroke of the left temporal lobe. Methods: We studied 13 patients with chronic fluent aphasia after an ischemic stroke involving Wernicke's area. iTBS was applied in random order to Wernicke's area, the right-hemisphere homologous of Wernicke's area, and the primary visual cortex. Auditory comprehension was blind assessed using the Token test before (T0), 5 (T1), and 40 min (T2) after a single session of iTBS. Results: At the first evaluation (T1) after iTBS on left Wernike's area, but not on the contralateral homologous area nor on the primary visual cortex, the scores on the Token test were significantly increased. No significant effects were observed at T2. Conclusion: We demonstrated that a single session of excitatory iTBS over Wernicke's area was safe and led to a transient facilitation of auditory comprehension in chronic stroke patients with lesions in the same area. Further studies are needed to establish whether TBS-induced modulation can be enhanced and transformed into longer-lasting effects by means of repeated TBS sessions and by combining TBS with speech and language therapy.

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“…Studies showed that high-intensity speech training can stimulate the corresponding brain language regions of patients and thus enable them to be gradually accustomed to normal language communication [ 17 , 18 ]. Neuroimaging-related studies exploring the change of brain areas concerning language and speech function after the training of CIAT showed that the activated areas primarily included the left hemisphere, such as left inferior frontal gyrus [ 19 ] and left middle frontal gyrus [ 20 ], which are considered language performance control regions.…”

Section: Introductionmentioning

confidence: 99%

Constraint-induced aphasia therapy for patients with aphasia: A systematic review

Wang

Zheng

et al. 2020

International Journal of Nursing Sciences

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Objectives This study aimed to systematically evaluate the effects of constraint-induced aphasia therapy (CIAT) for aphasic patients reported by randomized controlled trials. Methods Relevant randomized controlled trials were retrieved from 11 electronic databases. A methodological quality assessment was conducted in accordance with the Cochrane Handbook, and meta-analyses were performed by using RevMan 5.2. A descriptive analysis was conducted when the included trials were not suitable for a meta-analysis. Results A total of 12 trials were included. A statistically significant group difference was shown from the meta-analysis in the results measured by the Western Aphasia Battery (random-effects model, MD = 1.23, 95% CI = 0.31 to 2.14, P < 0.01). However, there were no statistically significant differences shown in the results of the Boston Naming Test (fixed-effects model, MD = −1.79, 95% CI = −11.19 to 7.62, P > 0.05) and Aachen Aphasia Test (fixed-effects model, MD = −1.11, 95% CI = −4.49 to 2.27, P > 0.05). The descriptive analysis showed positive results in language performances of naming, repetition, and comprehension. Conclusion This systematic review indicated that CIAT was efficient for improving language performance with regard to naming, comprehension, repetition, written language, and oral language based on the current evidence. And this review provides some meaningful guides for clinical practice: expand the therapy duration to 2 or 3 h per day, focus on naming, and choose the best assessment tool. It also indicates a need for more rigorous, large-scale, and high-quality trials in the future.

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A feasibility study of combined intermittent theta burst stimulation and modified constraint-induced aphasia therapy in chronic post-stroke aphasia

Cited by 21 publications

References 69 publications

Functional Magnetic Resonance Imaging of Language Following Constraint-Induced Aphasia Therapy Primed with Intermittent Theta Burst Stimulation in 13 Patients with Post-Stroke Aphasia

Functional Magnetic Resonance Imaging of Language Following Constraint-Induced Aphasia Therapy Primed with Intermittent Theta Burst Stimulation in 13 Patients with Post-Stroke Aphasia

Facilitation of Auditory Comprehension After Theta Burst Stimulation of Wernicke's Area in Stroke Patients: A Pilot Study

Constraint-induced aphasia therapy for patients with aphasia: A systematic review

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