Dataset Information

Clinical Feasibility of Combining Transcranial Direct Current Stimulation with Standard Aphasia Therapy.

ABSTRACT:

Background

Transcranial direct current stimulation (tDCS) is a safe, portable, and inexpensive form of noninvasive brain stimulation that appears to augment the effects of concurrent therapy. However, several methodological issues in existing studies distance tDCS from current clinical practice. In this study, we offered (and administered) tDCS to individuals seeking typical behavioral aphasia therapy on an outpatient basis.

Methods

We approached clients (n = 10) planning to receive standard aphasia therapy at a university clinic. Following a brief description of tDCS, we offered to provide stimulation during their therapy. Those interested and without contraindications participated in a double-blind, sham-controlled crossover study of tDCS paired with speech-language therapy provided twice weekly. Participants received active (2 mA) or sham tDCS during two eight-week therapy phases (separated by ten weeks) with the anode over Broca's area and the cathode on the contralateral forehead. Stimulation was provided for the first 20 minutes of each one-hour session. Prior to and following each phase, participants were video recorded telling the Cinderella narrative. Recordings were transcribed and analyzed for correct information units (CIUs).

Results

Seven individuals (70%) were interested in and eligible for tDCS. Data from four participants who completed the study indicated a large effect size favoring active over sham tDCS (Cohen's d = 1.32). The participant with the most severe deficits did not benefit from therapy in either condition.

Conclusion

There is potential for tDCS to enhance meaningful communication outcomes in standard clinical practice. Further investigation is needed to replicate findings and determine individual characteristics predictive of treatment response.

SUBMITTER: Duncan ES

PROVIDER: S-EPMC7731681 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

Clinical Feasibility of Combining Transcranial Direct Current Stimulation with Standard Aphasia Therapy.

Duncan E Susan ES Nakkawita Surani G SG

Annals of Indian Academy of Neurology 20200925 Suppl 2

<h4>Background</h4>Transcranial direct current stimulation (tDCS) is a safe, portable, and inexpensive form of noninvasive brain stimulation that appears to augment the effects of concurrent therapy. However, several methodological issues in existing studies distance tDCS from current clinical practice. In this study, we offered (and administered) tDCS to individuals seeking typical behavioral aphasia therapy on an outpatient basis.<h4>Methods</h4>We approached clients (n = 10) planning to recei ...[more]

PMID: 33343133

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Project description:Importance:Aphasia is a debilitating language disorder for which behavioral speech therapy is the most efficient treatment, but therapy outcomes are variable and full recovery is not always achieved. It remains unclear if adjunctive brain stimulation (anodal transcranial direct current stimulation [A-tDCS]) applied during aphasia therapy can improve outcomes. Objective:To examine the futility of studying A-tDCS as an adjunctive intervention during speech therapy to improve speech production (naming) for individuals with long-term poststroke aphasia. Design, Setting, and Participants:Double-blinded, prospective randomized clinical trial using a futility design to test adjunctive A-tDCS during speech therapy. The setting was an outpatient clinic. Enrollment of individuals began in August 2012 and was completed in March 2017, and the duration of follow-up was 6 months. Analyses began in April 2017. The study recruited from a volunteer sample, and 89 patients were screened. Patients with long-term (>6 months) aphasia due to 1 previous left hemisphere stroke were enrolled. In comparing A-tDCS and sham tDCS, patients were matched based on site (University of South Carolina or Medical University of South Carolina), baseline age, type of aphasia, and aphasia severity. Interventions:Outpatient speech therapy for 3 weeks (15 sessions, 45 minutes each) combined with either A-tDCS vs sham tDCS applied to preserved left temporal lobe regions. Main Outcomes and Measures:The primary outcome was the ability to name common objects, assessed twice before and after therapy. Results:A total of 74 patients were enrolled. Participants had a mean (SD) age of 60 (10) years, had 15 (2) years of education, and were 44 (40) months from stroke onset. There were 52 men (70%) and 62 non-Hispanic white individuals (84%). Most were retired or not employed (59 [80%]). Broca aphasia was the most common aphasia type (39 [52.7%]). The adjusted mean (SE) change from pretreatment baseline in correct naming was 13.9 (2.4) words (95% CI, 9.0-18.7) for A-tDCS and 8.2 (2.2) words (95% CI, 3.8-12.6) for sham tDCS, with mean (SE) A-tDCS difference of 5.7 (3.3) words (95% CI, -0.9 to 12.3), indicating a relative 70% increase in correct naming for A-tDCS relative to sham. The futility hypothesis P value was .90, indicating failure to reject the null hypothesis and, therefore, providing no evidence that further study of A-tDCS is futile. No serious adverse events were associated with A-tDCS. Conclusions and Relevance:Our findings provide motivation to proceed with another trial to study the effect of A-tDCS on the outcome of aphasia treatment in individuals poststroke. Anodal tDCS during speech therapy is feasible and potentially transformative for aphasia treatment and should be further studied. Trial Registration:ClinicalTrials.gov Identifier: NCT01686373.

Project description:BACKGROUND:Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been shown to improve common symptoms of neurological disorders like depressed mood, fatigue, motor deficits and cognitive dysfunction. tDCS requires daily treatment sessions in order to be effective. We developed a remotely supervised tDCS (RS-tDCS) protocol for participants with multiple sclerosis (MS) to increase accessibility of tDCS, reducing clinician, patient, and caregiver burden. The goal of this protocol is to facilitate home use for larger trials with extended treatment periods. In this study we determine the generalizability of RS-tDCS paired with cognitive training (CT) by testing its feasibility in participants with Parkinson's disease (PD). METHODS:Following the methods in our MS protocol development, we enrolled sixteen participants (n =?12 male, n =?4 female; mean age 66?years) with PD to complete ten open-label sessions of RS-tDCS paired with CT (2.0?mA?×?20?min) at home under the remote supervision of a trained study technician. Tolerability data were collected before, during, and after each individual session. Baseline and follow-up measures included symptom inventories (fatigue and sleep) and cognitive assessments. RESULTS:RS-tDCS was feasible and tolerable for patients with PD, with at-home access leading to high protocol compliance. Side effects were mostly limited to mild sensations of transient itching and burning under the electrode sites. Similar to prior finding sin MS, we found preliminary efficacy for improvement of fatigue and cognitive processing speed in PD. CONCLUSIONS:RS-tDCS paired with CT is feasible for participants with PD to receive at home treatment. Signals of benefit for reduced fatigue and improved cognitive processing speed are consistent across the PD and MS samples. RS-tDCS can be generalized to provide tDCS to a range of patients with neurologic disorders for at-home rehabilitation. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02746705 . Registered April 21st 2016.

Project description:While evidence suggests that transcranial direct current stimulation (tDCS) may facilitate language recovery in chronic post-stroke aphasia, individual variability in patient response to different patterns of stimulation remains largely unexplored. We sought to characterize this variability among chronic aphasic individuals, and to explore whether repeated stimulation with an individualized optimal montage could lead to persistent reduction of aphasia severity. In a two-phase study, we first stimulated patients with four active montages (left hemispheric anode or cathode; right hemispheric anode or cathode) and one sham montage (Phase 1). We examined changes in picture naming ability to address (1) variability in response to different montages among our patients, and (2) whether individual patients responded optimally to at least one montage. During Phase 2, subjects who responded in Phase 1 were randomized to receive either real-tDCS or to receive sham stimulation (10 days); patients who were randomized to receive sham stimulation first were then crossed over to receive real-tDCS (10 days). In both phases, 2 mA tDCS was administered for 20 min per real-tDCS sessions and patients performed a picture naming task during stimulation. Patients' language ability was re-tested after 2-weeks and 2-months following real and sham tDCS in Phase 2. In Phase 1, despite considerable individual variability, the greatest average improvement was observed after left-cathodal stimulation. Seven out of 12 subjects responded optimally to at least one montage as demonstrated by transient improvement in picture-naming. In Phase 2, aphasia severity improved at 2-weeks and 2-months following real-tDCS but not sham. Despite individual variability with respect to optimal tDCS approach, certain montages result in consistent transient improvement in persons with chronic post-stroke aphasia. This preliminary study supports the notion that individualized tDCS treatment may enhance aphasia recovery in a persistent manner.

Dataset Information

Clinical Feasibility of Combining Transcranial Direct Current Stimulation with Standard Aphasia Therapy.

Background

Methods

Results

Conclusion

Publications

Clinical Feasibility of Combining Transcranial Direct Current Stimulation with Standard Aphasia Therapy.

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