Randomized trial of iReadMore word reading training and brain stimulation in central alexia

Woodhead, Zoe; Kerry, Sally; Mejía, Óscar Mauricio Aguilar; Ong, Yean-Hoon; Hogan, John S; Pappa, Katerina; Leff, Alexander; Crinion, Jenny

doi:10.1093/brain/awy138

Cited by 32 publications

(32 citation statements)

References 69 publications

(84 reference statements)

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“…Participants achieved a large average dose of therapy, much larger than previous speech comprehension studies [6][7][8][9], and much closer to the large doses observed in positive intervention studies [10]. The effect size compares favourably with other lexical based interventions in reading [22] and naming [23]. Importantly, considering the amount of time and effort participants contributed, improvements for trained items were maintained up to 24 weeks after the therapy blocks were completed.…”

Section: Behavioural Therapy Effectsmentioning

confidence: 58%

Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

Fleming

Brownsett

Krason

et al. 2020

J Neurol Neurosurg Psychiatry

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ObjectiveThe efficacy of spoken language comprehension therapies for persons with aphasia remains equivocal. We investigated the efficacy of a self-led therapy app, ‘Listen-In’, and examined the relation between brain structure and therapy response.MethodsA cross-over randomised repeated measures trial with five testing time points (12-week intervals), conducted at the university or participants' homes, captured baseline (T1), therapy (T2-T4) and maintenance (T5) effects. Participants with chronic poststroke aphasia and spoken language comprehension impairments completed consecutive Listen-In and standard care blocks (both 12 weeks with order randomised). Repeated measures analyses of variance compared change in spoken language comprehension on two co-primary outcomes over therapy versus standard care. Three structural MRI scans (T2-T4) for each participant (subgroup, n=25) were analysed using cross-sectional and longitudinal voxel-based morphometry.ResultsThirty-five participants completed, on average, 85 hours (IQR=70–100) of Listen-In (therapy first, n=18). The first study-specific co-primary outcome (Auditory Comprehension Test (ACT)) showed large and significant improvements for trained spoken words over therapy versus standard care (11%, Cohen’s d=1.12). Gains were largely maintained at 12 and 24 weeks. There were no therapy effects on the second standardised co-primary outcome (Comprehensive Aphasia Test: Spoken Words and Sentences). Change on ACT trained words was associated with volume of pretherapy right hemisphere white matter and post-therapy grey matter tissue density changes in bilateral temporal lobes.ConclusionsIndividuals with chronic aphasia can improve their spoken word comprehension many years after stroke. Results contribute to hemispheric debates implicating the right hemisphere in therapy-driven language recovery. Listen-In will soon be available on GooglePlay.Trial registration numberNCT02540889.

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Section: Behavioural Therapy Effectsmentioning

confidence: 58%

Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

Fleming

Brownsett

Krason

et al. 2020

J Neurol Neurosurg Psychiatry

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“…It is a standardised test designed to measure reading progression in children and it produces a measure of words read per minute and participants' ability to comprehend what they are reading. The test was used in a recent study involving participants with central alexia (Woodhead et al, 2018). Level one and two texts from the test were included in the BoB protocol to obtain a measure of word and sentence reading comprehension.…”

Section: Text Reading (Neale)mentioning

confidence: 99%

Category-selective deficits are the exception and not the rule: Evidence from a case-series of 64 patients with ventral occipito-temporal cortex damage

Rice¹,

Kerry²,

Robotham³

et al. 2020

Preprint

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The organisational principles of the visual ventral stream are still highly debated, specifically the relative association/dissociation between word and face recognition. Reports of dissociations between word and face recognition stem from reports of category-selective impairments in single case-studies, and more recently neuroimaging investigations of healthy participants. Despite the historical reliance on single case-studies, more recent group studies have highlighted a greater commonality between word and face recognition. Studying individual patients with rare selective deficits misses (a) important variability between patients, (b) associations between task performance, and (c) patients with mild, severe and/or non-selective impairments; meaning that the full spectrum of deficits is unknown. The Back of the Brain project assessed the range and specificity of visual perceptual impairment in 64 patients with posterior cerebral artery stroke. Patients were recruited based on lesion localization and not behavioral performance. Group-level data-driven and single-subject case-series analyses revealed the full range of visual perceptual deficits. In both analyses, the general organisational principle was of associations between words and faces. Category-selective deficits were the exception and not the rule. This large-scale investigation of posterior cerebral artery stroke patients highlights the bilateral representation of visual perceptual function.

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“…Similar to stroke motor function parameters, in tDCS studies, the electrode placement aims to restore the interhemispheric unbalance between the residual left language areas and the right hemispheric ones [ 157 , 158 ]. Thus, two broad approaches have been usually adopted: facilitation of activity in lesioned or perilesional areas through anodal stimulation [ 19 , 20 , 21 , 22 , 23 , 24 , 27 , 28 , 30 , 134 , 135 , 136 , 138 , 139 , 141 , 142 , 143 , 144 , 145 , 146 , 149 , 150 , 151 , 153 , 156 ] or inhibition of the intact right hemisphere to diminish abnormal transcallosal inhibition through cathodal stimulation [ 20 , 133 , 137 , 140 , 145 , 152 , 154 ]. There were no reported side effects in any of the studies, even when tDCS was applied in a multiple session paradigm [ 127 , 128 ].…”

Section: Transcranial Direct Current Stimulation (Tdcs) Approachmentioning

confidence: 99%

“…Studies also included a mix of different types of aphasia classification (reporting either the patients’ scores or classifying their symptoms and/or considering their speech fluency) contributing to their extreme heterogeneity [ 127 ]. The classical modular approach has been most often adopted; thus, positioning the active electrode either over the left Broca’s area [ 19 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 132 , 135 , 142 , 144 , 145 , 150 , 151 , 156 ], the left Wernicke’s area [ 19 , 21 , 22 , 23 , 28 , 30 , 138 , 139 , 152 , 153 ] or the right homologues [ 20 , 133 , 137 , 145 , 147 , 152 , 154 , 155 ]. Indeed, most of the research has proven that anodal stimulation over these areas combined with language therapy increases different aspects of language.…”

Section: Transcranial Direct Current Stimulation (Tdcs) Approachmentioning

confidence: 99%

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

et al. 2021

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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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Randomized trial of iReadMore word reading training and brain stimulation in central alexia

Cited by 32 publications

References 69 publications

Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

Category-selective deficits are the exception and not the rule: Evidence from a case-series of 64 patients with ventral occipito-temporal cortex damage

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

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