Combination of Transcranial Direct Current Stimulation and Action Imitation Training in Post- Stroke Aphasia Rehabilitation: Implications from a Single Case Study.
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Feb 28, 2024
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Abstract
Background. One of the most used non-invasive brain stimulation (NIBS) techniques in aphasia rehabilitation is Anodal Transcranial Direct Current Stimulation (A-tDCS). Its application is supported by the fact that brain plasticity, when facilitated by language intervention, can be improved by non-invasive brain stimulation. The effects of neuromodulation combined with various language and communication therapies have led to promising results in the rehabilitation of patients presenting with acquired aphasia. An Action Observation Therapy such as IMITAF seems to contribute to improvements in language skills, mainly in naming. This experimental clinical protocol aims to investigate the rehabilitative potential of A-tDCS on perilesional areas, combined with computerized neuropsychological training.
Method. Participant: Mr. V., 66-year old right-handed male, Italian native speaker. The patient suffered an ischemic stroke due to left carotid artery dissection which resulted in right hemiparesis, mixed transcortical aphasia, characterized by non-fluent speech and dysarthric and disfluent speech. Treatment: The subject underwent unipolar montage stimulation, with anode placed in F5 and intra-cephalic reference on Fp2. For safety reasons, a stimulation intensity of 1.5 mA was applied for 20 minutes once a day in combination with IMITAF level I, which required the subject to repeat bisyllabic words.
Procedure: The stimulation protocol lasted a total of 4 weeks and was divided into 2 different modes. Clinical Training: 40-minute treatments (no.10 sessions) and involved the combined administration of a-tDCS (20-minute online mode) and 40-minute training. Home-Based Training: 40-minutes trainig carried out at the patient’s home, via PC (no. 8 sessions). Results. Mr. V. completed the protocol treatment sessions without reporting any adverse effects, such as scalp redness, tingling or headache. The results showed an improvement in the auditory/visual comprehension of words/sentences after A-tDCS and Action Observation Therapy, which has maintained one month after treatment.
Conclusions. Together with IMTAF neuropsychological training, the constant and repeated use of A-tDCS, on the perilesional areas, contributed to improvements in language skills thus promoting an overall recovery of communicative skills in an individual with chronic post-stroke non-fluent aphasia.
Article Details
How to Cite
VARINI, Matteo et al.
Combination of Transcranial Direct Current Stimulation and Action Imitation Training in Post- Stroke Aphasia Rehabilitation: Implications from a Single Case Study..
Medical Research Archives, [S.l.], v. 12, n. 2, feb. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5124>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i2.5124.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Crinion J. Transcranial direct current stimulation as a novel method for enhancing aphasia treatment effects. European Psychologist. 2016;21(1):65-77. doi:10.1027/1016-9040/a000254
3. Wade DT, Hewer RL, David R, Enderby P. Aphasia after stroke: natural history and associated deficits. Journal of Neurology, Neurosurgery, and Psychiatry. 1986;49(1):11-16. doi:10.1136/jnnp.49.1.11
4. Watila MM, Balarabe SA. Factors predicting post-stroke aphasia recovery. Journal of the Neurological Sciences. 2015;352(1-2):12-18. doi:10.1016/j.jns.2015.03.020
5. Hamilton RH. Neuroplasticity in the language system: Reorganization in post-stroke aphasia and in neuromodulation interventions. Restorative Neurology and Neuroscience. 2016;34(4):467-471. doi:10.3233/rnn-169002
6. Astrup J, Siesjö BK, Symon L. Thresholds in cerebral ischemia - the ischemic penumbra. Stroke. 1981;12(6):723-725. doi:10.1161/01.str.12.6.723
7. Hillis AE, Wityk RJ, Barker PB, Caramazza A. Neural regions essential for writing verbs. Nature Neuroscience. 2002;6(1):19-20. doi:10.1038/nn982
8. Hillis AE, Kleinman JT, Newhart M, et al. Restoring cerebral blood flow reveals neural regions critical for naming. The Journal of Neuroscience. 2006;26(31):8069-8073. doi:10.1523/jneurosci.2088-06.2006
9. Carrera E, Jones PS, Morris RS, et al. Is neural activation within the rescued penumbra impeded by selective neuronal loss? Brain. 2013;136(6):1816-1829. doi:10.1093/brain/awt112
10. Thiel A, Heiss W. Imaging of microglia activation in stroke. Stroke. 2011;42(2):507-512. doi:10.1161/strokeaha.110.598821
11. Turken AU, Dronkers NF. The Neural Architecture of the Language Comprehension Network: Converging Evidence from Lesion and Connectivity Analyses. Frontiers. 2011;5. doi:10.3389/fnsys.2011.00001
12. Thompson CK, Ouden DBD. Neuroimaging and recovery of language in aphasia. Current Neurology and Neuroscience Reports. 2008;8(6):475-483. doi:10.1007/s11910-008-0076-0
13. Saur D, Lange R, Baumgaertner A, et al. Dynamics of language reorganization after stroke. Brain. 2006;129(6):1371-1384. doi:10.1093/brain/awl090
14. Turkeltaub PE, Messing SB, Norise C, Hamilton RH. Are networks for residual language function and recovery consistent across aphasic patients? Neurology. 2011;76(20):1726-1734. doi:10.1212/wnl.0b013e31821a44c1
15. Turkeltaub PE, Coslett HB, Thomas A, et al. The right hemisphere is not unitary in its role in aphasia recovery. Cortex. 2012;48(9):1179-1186. doi:10.1016/j.cortex.2011.06.010
16. Shimizu T, Hosaki A, Hino T, et al. Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke. Brain. 2002;125(8):1896-1907. doi:10.1093/brain/awf183
17. Thiel A, Habedank B, Herholz K, et al. From the left to the right: How the brain compensates progressive loss of language function. Brain and Language. 2006;98(1):57-65. doi:10.1016/j.bandl.2006.01.007
18. Winhuisen L, Thiel A, Schumacher B, et al. Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia. Stroke. 2005;36(8):1759-1763. doi:10.1161/01.str.0000174487.81126.ef
19. Cheng W, Li Y, Cheng B, et al. Effects of transcranial direct current stimulation over the right hemisphere on naming ability in patients with poststroke aphasia: A meta-analysis. Journal of Neurolinguistics. 2021;58:100986. doi:10.1016/j.jneuroling.2021.100986
20. Heiss W, Thiel A. A proposed regional hierarchy in recovery of post-stroke aphasia. Brain and Language. 2006;98(1):118-123. doi:10.1016/j.bandl.2006.02.002
21. Torres J, Drebing D, Hamilton RH. TMS and tDCS in post-stroke aphasia: Integrating novel treatment approaches with mechanisms of plasticity. Restorative Neurology and Neuroscience. 2013;31(4):501-515. doi:10.3233/rnn-130314
22. Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: A critical review of literature. Brain Injury. 2014;28(2):138-145. doi:10.3109/02699052.2013.859734
23. Meinzer M, Flaisch T, Breitenstein C, Wienbruch C, Elbert T, Rockstroh B. Functional re-recruitment of dysfunctional brain areas predicts language recovery in chronic aphasia. NeuroImage. 2008;39(4):2038-2046. doi:10.1016/j.neuroimage.2007.10.008
24. Zettin M, Bondesan C, Nada G, Varini M, Dimitri D. Transcranial Direct-Current Stimulation and Behavioral Training, a promising tool for a Tailor-Made Post-stroke Aphasia rehabilitation: A review. Frontiers in Human Neuroscience. 2021;15. doi:10.3389/fnhum.2021.742136
25. van Oers, C. A. M. M., Vink, M., van Zandvoort, M. J. E., van der Worp, H. B., de Haan, E. H. F., Kappelle, L. J., Ramsey, N. F., & Dijkhuizen, R. M. (2010). Contribution of the left and right inferior frontal gyrus in recovery from aphasia. A functional MRI study in stroke patients with preserved hemodynamic responsiveness. NeuroImage, 49(1), 885–893. https://doi.org/10.1016/j.neuroimage.2009.08.057
26. Marcotte K, Adrover‐Roig D, Damien B, et al. Therapy-induced neuroplasticity in chronic aphasia. Neuropsychologia. 2012;50(8):1776-1786. doi:10.1016/j.neuropsychologia.2012.04.001
27. Thiel A, Zumbansen A. The pathophysiology of post-stroke aphasia: A network approach. Restorative Neurology and Neuroscience. 2016;34(4):507-518. doi:10.3233/rnn-150632
28. Krönke KM, Mueller K, Friederici AD, Obrig H. Learning by doing? The effect of gestures on implicit retrieval of newly acquired words. Cortex. 2013;49(9):2553-2568. doi:10.1016/j.cortex.2012.11.016
29. Hanlon RE, Lux WE, Dromerick AW. Global aphasia without hemiparesis: language profiles and lesion distribution. Journal of Neurology, Neurosurgery, and Psychiatry. 1999;66(3):365-369. doi:10.1136/jnnp.66.3.365
30. Small SL, Llano DA. Biological approaches to aphasia treatment. Current Neurology and Neuroscience Reports. 2009;9(6):443-450. doi:10.1007/s11910-009-0066-x
31. Looeiyan N, Kianfar F, Ghasisin L. The introduction of IMITATE-R and its comparison with the IMITATE treatment method in the naming ability of two Persian speaking aphasic patients. Neuropsychological Rehabilitation. 2018;30(4):709-730. doi:10.1080/09602011.2018.1496940
32. Zettin M, Leopizzi M, Galetto V. How does language change after an intensive treatment on imitation? Neuropsychological Rehabilitation. 2018;29(9):1332-1358. doi:10.1080/09602011.2017.1406861
33. Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. The Neuroscientist. 2011;17(1):37-53. doi:10.1177/1073858410386614
34. Sacco K, Galetto V, Dimitri D, et al. Concomitant use of transcranial direct current stimulation and Computer-Assisted training for the rehabilitation of attention in traumatic brain injured patients: behavioral and neuroimaging results. Frontiers in Behavioral Neuroscience. 2016;10. doi:10.3389/fnbeh.2016.00057
35. Brown RE. Donald O. Hebb and the Organization of Behavior: 17 years in the writing. Molecular Brain. 2020;13(1). doi:10.1186/s13041-020-00567-8
36. Capasso, R., & Miceli, G. (2001). Esame Neuropsicologico per l'Afasia: ENPA (Vol. 4). Springer Science & Business Media.
37. Luzzatti C, Davidoff J. Impaired retrieval of object-colour knowledge with preserved colour naming. Neuropsychologia. 1994;32(8):933-950. doi:10.1016/0028-3932(94)90044-2
38. Zimmermann P., and Fimm, B. Testbatterie zur Aufmerksamkeitsprüfung (TAP). Würselen: Psytest, 1992.
39. Spinnler H, Tognoni G (1987) Standardizzazione e taratura italiana di test neuropsicologici. Ital J Neurol Sci suppl 8 to 6: 1–120
40. Nitsche MA, Doemkes S, Karaköse T, et al. Shaping the effects of transcranial direct current stimulation of the human motor cortex. Journal of Neurophysiology. 2007;97(4):3109-3117. doi:10.1152/jn.01312.2006
41. De Aguiar V, Bastiaanse R, Capasso R, et al. Can tDCS enhance item-specific effects and generalization after linguistically motivated aphasia therapy for verbs? Frontiers in Behavioral Neuroscience. 2015;9. doi:10.3389/fnbeh.2015.00190
42. Bikson M, Grossman P, Thomas C, et al. Safety of transcranial direct current stimulation: Evidence Based Update 2016. Brain Stimulation. 2016;9(5):641-661. doi:10.1016/j.brs.2016.06.004
43. Antal A, Alekseichuk I, Bikson M, et al. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clinical Neurophysiology. 2017;128(9):1774-1809. doi:10.1016/j.clinph.2017.06.001
44. Lefaucheur JP, Antal A, Ayache SS, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology. 2017;128(1):56-92. doi:10.1016/j.clinph.2016.10.087
45. Brady M, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database of Systematic Reviews. Published online May 16, 2012. doi:10.1002/14651858.cd000425.pub3
46. Filippetti, M., Amico, A. P., Mazzucchelli, M., Perin, C., Cornaggia, C. M., Megna, M. (2021). Tecniche di stimolazione cerebrale non invasiva: la stimolazione elettrica transcranica. Revisione Narrativa Della Letteratura. Giornale italiano di Medicina Riabilitativa, 36(3), 23-29.
47. Galletta EE, Vogel-Eyny A. Translational treatment of aphasia combining neuromodulation and behavioral intervention for lexical retrieval: implications from a single case study. Frontiers in Human Neuroscience. 2015;9. doi:10.3389/fnhum.2015.00447
48. Chase HW, Boudewyn MA, Carter CS, Phillips ML. Transcranial direct current stimulation: a roadmap for research, from mechanism of action to clinical implementation. Molecular Psychiatry. 2019;25(2):397-407. doi:10.1038/s41380-019-0499-9
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