Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial

Abstract

Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex—that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03629665

EEG Artifact Removal in TMS Studies of Cortical Speech Areas

“…For instance in the future, studying, the causal connections with the presented TMS-EEG data-analysis methods could reveal more about the cognitive processing of speech as discussed in (Carreiras et al 2012). Consequently, the investigation of individual causal connections of speech areas could help to find the optimal stimulation sites for rTMS therapies (Hamilton et al 2011) of speech networks in, for example, stroke-related aphasia (Hamilton et al 2011;Thiel et al 2013;Hartwigsen et al 2017;Heikkinen et al 2019). The network-level mechanisms of these rTMS therapies in the rehabilitation of aphasia are still unknown but the current development in the offline data-cleaning methods shows the promise of TMS-EEG for probing these open questions.…”

“…However, the reliable estimation of effective connectivity parameters (Salo et al 2018) within the language network could improve our understanding of the interplay and functions of the various speech-related cortical areas. Hence, this information could be directly used in the planning of therapeutic TMS protocols to treat language impairments, for example, those caused by stroke or other pathophysiologies (Hamilton et al 2011;Carreiras et al 2012;Thiel et al 2013;Heikkinen et al 2019).…”

New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia

“…In the report on the acute phase, the study of Waldowski et al was classified during the acute phase [30]. In the subacute phase (30 to 90 days), seven studies were classified [16,18,19,23,[25][26][27]. In the study by Heiss et al, the stimulation site was different between right-handed and left-handed individuals [27].…”

People with non-fluent aphasia initiating actions in everyday conversation with familiar conversation partners: resources for participation

“…Intensive Language-Action Therapy (ILAT) (see Heikkinen et al, 2019). The latter is an established aphasia therapy method implemented in a small group with the aim of encouraging PWA to use spoken language for requesting an object or proposing an activity (Difrancesco et al, 2012).…”