The Current Role of Neuromodulation in the Intervention of Post-Stroke Aphasia

Year 2024, , 226 - 256, 29.08.2024

Hazel Zeynep Kurada

https://doi.org/10.58563/dkyad-2024.72.5

Abstract

Purpose: Aphasia is a complex language disorder that occurs when the language centers of the brain are damaged. It involves difficulties in speaking, understanding, and repeating language. Aphasia primarily impacts the language regions in the left hemisphere of the brain, causing significant disruptions in communication skills and creating significant challenges for persons in their daily activities and overall well-being. Speech and language therapy is widely acknowledged as the foundation of aphasia rehabilitation. It plays a crucial role in helping individuals regain their communication abilities and accelerating their path to recovery. Recently, non-invasive brain stimulation approaches have become a promising addition to standard therapy for managing aphasia. Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) are methods that have gained attention for their potential effectiveness, especially in treating post-stroke aphasia. These therapies work by adjusting neural activity in specific areas of the brain that are involved in language processing. This helps improve language recovery and enhance communication results. This comprehensive review aims to investigate the applications and protocols of brain stimulation used in the rehabilitation of post-stroke aphasia. The main goal is to increase knowledge of different therapeutic options in clinical settings by carefully analyzing the existing state of neurostimulation practices. Furthermore, this review aims to stimulate additional theoretical or experimental research by highlighting current patterns and important discoveries in the literature on aphasia neurostimulation.

Method: A literature review was conducted using databases such as PubMed and Google Scholar with search terms like “TMS,” “tDCS,” “aphasia,” “post-stroke aphasia,” and “non-fluent chronic aphasia” to identify current and relevant studies in this field. The search results were compiled by categorizing the studies annually and reviewing content specific to the topic.

Results: The review findings suggest that neuromodulatory tools, particularly when combined with standard speech and language therapy, accelerate the recovery process in post-stroke aphasia rehabilitation and support language skills such as fluency, naming, and repetition. These integrative therapies have shown promise in strengthening basic language abilities. Despite the positive progress, there are still many important questions that are uncertain. Further empirical research is needed to determine the effectiveness, dependability, and best stimulation parameters required to produce long-lasting therapeutic benefits. Moreover, a thorough understanding of the neurobiological foundations is essential for improving these interventions and maximizing their effectiveness in managing post-stroke aphasia. The review findings provide information on current practices and encourage further research in aphasia management. It highlights the potential of neurostimulation techniques to become a crucial part of aphasia rehabilitation strategies.

Conclusion: Though more research is needed to fully understand how these therapeutic effects work, how safe they are, the best stimulation parameters for long-term effects, and how they work, brain stimulation techniques seem to be useful for rehabilitating people with aphasia, improving both their communication skills and quality of life.

Keywords

aphasia, post-stroke aphasia, neuromodulation, transcranial magnetic stimulation, transcranial direct current stimulation

Nöromodülasyon Kavramı ve İnme Sonrası Afazi Müdahalesindeki Güncel Rolü

Abstract

Amaç: Afazi, beyinin sol hemisferindeki dil alanlarının hasar görmesiyle ortaya çıkar. Bu durum, iletişim yeteneklerinin derinden etkilenmesine yol açmaktadır. Altın standart olarak kabul edilen dil ve konuşma terapisi, afazi rehabilitasyonunda ve iletişim becerilerinin yeniden kazandırılmasında kritik öneme sahiptir. Geleneksel terapi yaklaşımının yanı sıra, son yıllarda giderek yaygınlaşan Transkraniyal Manyetik Uyarım ve Transkraniyal Doğru Akım Uyarımı gibi girişimsel olmayan beyin uyarımı yöntemlerinin de özellikle inme sonrası afazi yönetiminde etkili olduğu öne sürülmektedir. Bu derleme yazısında inme sonrası afazi rehabilitasyonunda kullanılan beyin uyarımı uygulamaları ve çeşitli uyarım protokolleri incelenerek, klinik pratikte bu tür alternatif uygulamalara yönelik farkındalığı artırmak, afazide nöromodülasyon uygulamalarına ilişkin alanyazın yönelim ve bulgularını ortaya koyarak kuramsal ya da deneysel çalışmaları teşvik etmek ve bu konuda çalışma yapmayı düşünenler için genel bir çerçeve oluşturmak amaçlanmıştır.

Yöntem: Literatür taraması, “TMS”, “tDCS”, “aphasia”, “post-stroke aphasia” ve “non-fluent chronica aphasia” gibi arama terimleri ile PubMed ve Google Scholar gibi veri tabanları kullanılarak gerçekleştirilmiştir. Arama sonuçları, çalışmaların yıllık bazda sınıflandırılması ve konuya özgü içeriklerin incelenmesiyle derlenmiştir.

Bulgular: Derlemeden ortaya çıkan sonuçlar, nöromodülatör araçların inme sonrası afazi rehabilitasyonunda özellikle standart dil ve konuşma terapisi ile kombine edildiğinde iyileşme sürecini hızlandırdığını, akıcılık, adlandırma ve tekrarlama gibi dil becerilerini desteklediğini göstermektedir.

Sonuç: Beyin uyarım yöntemlerinin inme sonrası afazi yönetimindeki etkililiği, güvenirliği, uzun dönem etkileri için gereken optimal stimülasyon parametreleri ve ayrıca terapötik etkilerinin altında yatan mekanizmaları aydınlatmak için daha fazla çalışmaya ihtiyaç duyulsa da bu teknikler afazi rehabilitasyonunda hem iletişim becerilerini hem de yaşam kalitesini artırmak adına değerli bir araç haline gelmiş görünmektedir.

Keywords

afazi, inme sonrası afazi, nöromodülasyon, transkraniyal manyetik stimülasyon, transkraniyal doğru akım uyarımı

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