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Transcranial Magnetic Stimulation and Aphasia Rehabilitation

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Abstract

Naeser MA, Martin PI, Ho M, Treglia E, Kaplan E, Bashir S, Pascual-Leone A. Transcranial magnetic stimulation and aphasia rehabilitation.

Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005. In part 1, we review the rationale for applying slow, 1-Hz, rTMS to the undamaged right hemisphere in chronic nonfluent aphasia patients after a left hemisphere stroke; and we present a transcranial magnetic stimulation (TMS) protocol used with these patients that is associated with long-term, improved naming post-TMS. In part 2, we present results from a case study with chronic nonfluent aphasia where TMS treatments were followed immediately by speech therapy (constraint-induced language therapy). In part 3, some possible mechanisms associated with improvement after a series of TMS treatments in stroke patients with aphasia are discussed.

Section snippets

Rationale

Functional imaging studies of language in patients with nonfluent aphasia frequently reveal an increased activation (possible overactivation) in RH language homologues.10, 11, 12, 13, 14 It is possible that unusually high activation in the RH is related to transcallosal disinhibition leading only to partial, or incomplete, recovery. Such increased RH activation would represent maladaptive plasticity, and lead to a dead-end, inefficient strategy for recovery.2, 10, 12, 14, 15

Several studies have

Background and Rationale

CILT is an intensive speech therapy program shown to significantly improve naming after a series of 10 CILT treatments.52, 53, 54 During CILT, patients are only allowed to respond with verbal naming for a picture (no gestures or writing or sound effects are permitted). An opaque screen is placed on a table where the speech-language pathologist (SLP) is seated on 1 side, and the patient on the other. There is eye contact above the screen, but it is not possible for the patient to use hand

Possible Mechanisms

The mechanisms associated with language improvement post-TMS treatments in chronic stroke patients with aphasia are unknown. The presence of a differential effect on naming after suppression of right PTr (facilitation of naming) versus suppression of right POp (impairment of naming) during Phase 1 by Naeser et al43 in nonfluent aphasia patients may provide some insight regarding the potential role of right POp in aphasia. This differential effect suggests potential for different pathways with

Conclusions

In summary, the TMS studies by Naeser et al,33, 36, 37, 49 as well as these new TMS studies,73, 74 all suggest that use of 1-Hz rTMS for a series of at least 10 rTMS treatments results in significant improvement in naming, and often in phrase length during propositional speech. These improvements are long-lasting, up to 2 months, or even as long as 2 years, post- TMS.33, 36, 37, 49, 50 Functional imaging studies report significant improvement in naming in those cases with new LH activation50 or

Acknowledgements

The authors would like to thank Anna Kharaz, BS, for data collection and literature searches.

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    Supported by the National Institutes of Health (grant no. RO1 DC05672) from the National Institute on Deafness and Other Communication Disorders (NIDCD), Bethesda, MD, and a grant from the Medical Research Service, Department of Veterans Affairs, Washington, DC; a K24 National Institutes of Health award (award no. RRO18875); the Harvard-Thorndike General Clinical Research Center (grant no. NCRR MO1 RR01032); the Harvard Clinical and Translational Science Center (grant no. UL1 RR025758); and a NIDCD grant to the Harold Goodglass BU Aphasia Research Center (grant no. P30 DC05207).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Clinical Trials Registration No: NCT00608582.

    Reprints are not available from the author.

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