Efficacy of Bihemispheric tDCS in Rehabilitation of Non-Fluent Aphasia: A Single-subject Pilot Study

Year 2024, Volume: 14 Issue: 3, 595 - 603, 30.09.2024

Dilara Gamze Aydın , Talat Bulut , Çağdaş Karsan

https://doi.org/10.33808/clinexphealthsci.1091127

Abstract

Objective: Transcranial direct current stimulation (tDCS) has emerged as a potentially effective complementary tool in rehabilitation of aphasia. However, there is no consensus regarding the optimal tDCS montage to augment language outcomes in aphasia. Against this background, the present study aimed to examine efficacy of tDCS combined with language therapy in aphasia rehabilitation and to compare two different montages.
Methods: A right-handed participant suffering from chronic, non-fluent aphasia following stroke affecting the left hemisphere underwent a 5-week procedure involving tDCS coupled with language therapy. The procedure comprised two 5-day treatments of bihemispheric tDCS (over inferior frontal and posterior temporal sites determined using the international 10-20 EEG system). As part of both treatments, the left hemispheric targets were excited through anodal tDCS while simultaneously inhibiting their right-hemispheric homologues through cathodal tDCS. Baseline, post-treatment and follow-up assessments were obtained using a comprehensive language assessment tool.
Results: An increase in language outcomes, particularly in repetition, was observed following the treatments. It was also found that therapy gains were more robust following bihemispheric stimulation of the posterior temporal sites compared to the inferior frontal targets.
Conclusion: Bihemispheric tDCS coupled with language therapy appears to be effective in remediating language symptoms, particularly in terms of the repetition ability, in aphasia.

Keywords

Aphasia, stroke, tDCS, brain stimulation, rehabilitation

References

• Goodglass, H, Kaplan E. The Assessment of Aphasia and Related Disorders. 2nd ed. Philadelphia: Lea and Febiger; 1983.
• Hornauer-Hughes A, González Victoriano R. Description of verbal and non-verbal ability in 280 patients with aphasia caused by stroke. J Neurol Sci. 2015;357:434–435. DOI:10.1016/j.jns.2015.09.061
• Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2016;6:1-315. DOI: 10.1002/14651858.CD000425.pub4
• Holland R, Crinion J. Can tDCS enhance treatment of aphasia after stroke? Aphasiology 2012;26(9):1169–1191. DOI:10.1080/02687.038.2011.616925
• Lazar RM, Minzer B, Antoniello D, Festa JR, Krakauer JW, Marshall RS. Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke 2010;41(7):1485–1488. DOI: 10.1161/STROKEAHA.109.577338
• Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke 2003;34(4):987–993. DOI:10.1161/01.STR.000.006.2343.64383.D0
• Harvey S, Carragher M, Dickey MW, Pierce JE, Rose ML. Dose effects in behavioural treatment of post-stroke aphasia: A systematic review and meta-analysis. Disabil Rehabil. 2020;1–12. DOI: 10.1080/09638.288.2020.1843079
• Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M, De Ridder D, Ferrucci R, Langguth B, Marangolo P, Mylius V, Nitsche MA, Padberg F, Palm U, Poulet E, Priori A, Rossi S, Schecklmann M, Vanneste S, Ziemann U, Garcia-Larrea L, Paulus W. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017;128(1):56–92. DOI: 10.1016/j.clinph.2016.10.087
• Marangolo P, Fiori V, Calpagnano MA, Campana S, Razzano C, Caltagirone C, Marini A. tDCS over the left inferior frontal cortex improves speech production in aphasia. Front Hum Neurosci. 2013;7:1–10. DOI:10.3389/fnhum.2013.00539
• Marangolo P, Fiori V, Campana S, Antonietta Calpagnano M, Razzano C, Caltagirone C, Marini A. Something to talk about: Enhancement of linguistic cohesion through tdCS in chronic non fluent aphasia. Neuropsychologia. 2014;53(1):246–256.DOI: 10.1016/j.neuropsychologia.2013.12.003
• Campana S, Caltagirone C, Marangolo P. Combining voxelbased lesion-symptom mapping (VLSM) with A-tDCS language treatment: Predicting outcome of recovery in nonfluent chronic aphasia. Brain Stimul. 2015;8(4):769–776. DOI:10.1016/j.brs.2015.01.413
• Kang EK, Kim YK, Sohn HM, Cohen LG, Paik NJ. Improved picture naming in aphasia patients treated with cathodal tDCS to inhibit the right Broca’s homologue area. Restor Neurol Neurosci. 2011;29(3):141–152. DOI: 10.3233/RNN-2011-0587
• Biou E, Cassoudesalle H, Cogné M, Sibon I, De Gabory I, Dehail P, Aupy J, Glize B. Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review. Ann Phys Rehabil Med. 2019;62(2):104–121. DOI: 10.1016/j.rehab.2019.01.003
• de Aguiar V, Paolazzi CL, Miceli G. tDCS in post-stroke aphasia: The role of stimulation parameters, behavioral treatment and patient characteristics. Cortex 2015;63:296–316. DOI:10.1016/j.cortex.2014.08.015
• Duncan Es, Pradeep A, Small S. A review of biological interventions in chronic aphasia. Ann Indian Acad Neurol. 2020;23(8):82–94. DOI: 10.4103/aian.AIAN_549_20
• Polanowska KE, Leśniak MM, Seniów JB, Czepiel W, Członkowska A. Anodal transcranial direct current stimulation in early rehabilitation of patients with post-stroke non-fluent aphasia: A randomized, double-blind, sham-controlled pilot study. Restor Neurol Neurosci. 2013;31(6):761–771. DOI:10.3233/RNN-130333
• Volpato C, Cavinato M, Piccione F, Garzon M, Meneghello F, Birbaumer N. Transcranial direct current stimulation (tDCS) of Broca’s area in chronic aphasia: A controlled outcome study. Behav Brain Res. 2013;247:211–216. DOI: 10.1016/j.bbr.2013.03.029
• Spielmann K, van de Sandt-Koenderman WME, Heijenbrok-Kal MH, Ribbers GM. Transcranial direct current stimulation does not improve language outcome in subacute poststroke aphasia. Stroke. 2018;49(4):1018–1020. DOI: 10.1161/STROKEAHA.117.020197
• da Silva FR, Mac-Kay APMG, Chao JC, dos Santos MD, Gagliadi RJ. Transcranial direct current stimulation: A study on naming performance in aphasic individuals. CoDAS. 2018;30(5):1–6. DOI: 10.1590/2317-1782/201.820.17242
• Galletta EE, Cancelli A, Cottone C, Simonelli I, Tecchio F, Bikson M, Marangolo P. Use of computational modeling to inform tDCS Electrode montages for the promotion of language recovery in post-stroke aphasia. Brain Stimul. 2015;8(6):1108–1115. DOI: 10.1016/j.brs.2015.06.018
• Toğram B, Maviş İ. Afazi dil değerlendirme testi’nin geçerlik, güvenirlik ve standardizasyon çalışması. Türk Nöroloji Dergisi 2012;18(3):96–103. DOI: 10.4274/Tnd.16779. (Turkish).
• Worthington AD. Single case design experimentation. Br J Ther Rehabil. 1995;2(10):536–538. DOI: 10.12968/ bjtr.1995.2.10.536
• Boyle M, Coelho CA. Application of semantic feature analysis as a treatment for aphasic dysnomia. Am J Speech-Language Pathol. 1995;4(4):94–98. DOI: 10.1044/1058-0360.0404.94
• Johnson JP, Meier EL, Pan Y, Kiran S. Pre-treatment graph measures of a functional semantic network are associated with naming therapy outcomes in chronic aphasia. Brain Lang. 2020;207:104809. DOI: 10.1016/j.bandl.2020.104809
• Maviş İ, Toğram B. Afazi Dil Değerlendirme Testi. 1st ed. Detay Yayıncılık; 2009. (Turkish)
• R Core Team. R. A language and environment for statistical computing. R Found Stat Comput Vienna, Austria 2013.
• Yaşa İC, Maviş İ, Şalçini C, Midi İ. Comparing the efficiency of speech and language therapy and transcranial magnetic stimulation for treating Broca’s aphasia. J Stroke Cerebrovasc Dis. 2023;32(6):107108. DOI:10.1016/j.jstrokecerebrovasdis.2023.107108
• Ding X, Zhang S, Huang W, Zhang S, Zhang L, Hu J, Li J, Ge Q, Wang Y, Ye X, Zhang J. Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: A network meta-analysis and meta-regression of moderators. Neurosci Biobehav Rev. 2022;140:104804. DOI: 10.1016/j.neubiorev.2022.104804
• Guillouët E, Cogné M, Saverot E, Roche N, Pradat-Diehl P, Weill-Chounlamountry A, Ramel V, Taratte C, Lachasse AG, Haulot JA, Vaugier I, Barbot F, Azouvi P, Charveriat S. Impact of combined transcranial direct current stimulation and speechlanguage therapy on spontaneous speech in aphasia: A randomized controlled double-blind study. J Int Neuropsychol Soc. 2020;26(1):7–18. DOI: 10.1017/S135.561.7719001036
• Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Cochrane Database Syst Rev. 2019;2019(5):1–42. DOI: 10.1002/14651858.CD009760.pub4
• Marangolo P, Marinelli CV, Bonifazi S, Fiori V, Ceravolo MG, Provinciali L, Tomaiuolo F. Electrical stimulation over the left inferior frontal gyrus (IFG) determines long-term effects in the recovery of speech apraxia in three chronic aphasics. Behav Brain Res. 2011;225(2):498–504. DOI: 10.1016/j.bbr.2011.08.008
• Marangolo P, Fiori V, Cipollari S, Campana S, Razzano C, Di Paola M, Koch G, Caltagirone C. Bihemispheric stimulation over left and right inferior frontal region enhances recovery from apraxia of speech in chronic aphasia. Eur J Neurosci. 2013;38(9):3370–3377. DOI: 10.1111/ejn.12332
• Marangolo P, Fiori V, Sabatini U, De Pasquale G, Razzano C, Caltagirone C, Gili T. Bilateral transcranial direct current stimulation language treatment enhances functional connectivity in the left hemisphere: Preliminary data from aphasia. J Cogn Neurosci. 2016;28(5):724–738. DOI: 10.1162/jocn_a_00927
• Cipollari S, Veniero D, Razzano C, Caltagirone C, Koch G, Marangolo P. Combining TMS-EEG with transcranial direct current stimulation language treatment in aphasia. Expert Rev Neurother. 2015;15(7):833–845. DOI:10.1586/14737.175.2015.1049998
• Fiori V, Coccia M, Marinelli C V., Vecchi V, Bonifazi S, Ceravolo MG, Provinciali L, Tomaiuolo F, Marangolo P. Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects. J Cogn Neurosci. 2011;23(9):2309– 2323. DOI: 10.1162/jocn.2010.21579
• You DS, Kim DY, Chun MH, Jung SE, Park SJ. Cathodal transcranial direct current stimulation of the right Wernicke’s area improves comprehension in subacute stroke patients. Brain Lang. 2011;119(1):1–5. DOI:10.1016/j.bandl.2011.05.002
• Fridriksson J, Richardson JD, Baker JM, Rorden C. Transcranial direct current stimulation improves naming reaction time in fluent aphasia. Stroke 2011;42(3):819–821. DOI: 10.1161/STROKEAHA.110.600288
• Torres J, Drebing D, Hamilton R. TMS and tDCS in poststroke aphasia: Integrating novel treatment approacheswith mechanisms of plasticity. Restor Neurol Neurosci. 2013;31(4):501–515. DOI: 10.3233/RNN-130314
• Galletta EE, Rao PR, Barrett AM. Transcranial magnetic stimulation (TMS): Potential progress for language improvement in aphasia. Top Stroke Rehabil. 2011;18(2):87–91. DOI: 10.1310/tsr1802-87
• Hummel FC, Cohen LG. Non-invasive brain stimulation: A new strategy to improve neurorehabilitation after stroke? Lancet Neurol. 2006;5(8):708–712. DOI: 10.1016/S1474-4422(06)70525-7