Stroke, Aphasia
Conditions
Brief summary
The aim of this study is to assess the safety and clinical efficacy of high or low-frequency repetitive transcranial magnetic stimulation based on brain activation with functional near infrared spectroscopy in poststroke nonfluent aphasia patients.
Detailed description
In poststsroke aphasia rehabilitation, repetitive transcranial stimulation (rTMS) studies aimed to reinforce the activity of the brain regions in the left hemisphere. This goal can be achieved by using an excitatory protocol to reactivate the perilesional area or inhibitory protocol to reduce activities in the contralesional area. However, most conventional rTMS studies employed an inhibitory low frequency protocol for the contralesional homologs of Broca's area. In the present pilot study, investigators will perform functional near-infrared spectroscopy (fNIRS) prior to rTMS treatment for selection of the most appropriate application of stimulation. Stimulation site and protocol (high frequency or low frequency rTMS) will be determined by activation pattern from the fNIRS findings with language task in individual patients.
Interventions
DEVICEHigh frequency rTMS
Most activated area from fNIRS findings: Perileisional Broca's area, High frequency rTMS (10Hz), Number of total stimuli: 800, Location: perilesional Broca's area, Intensity: 100% of resting motor threshold, Coil orientation: tangential to scalp, in combination with speech therapy(35-40min) after each rTMS session, Daily 10 treatment session
DEVICELow frequency rTMS
Most activated area from fNIRS findings: Contralesional homologs of Broca's area, Low frequency rTMS (1Hz), Number of total stimuli: 1200, Location: Contralesional homologs of Broca's area (Pars triangularis), Intensity: 90% of resting motor threshold, Coil orientation: tangential to scalp, in combination with speech therapy(35-40min) after each rTMS session, Daily 10 treatment session
Sponsors
Seoul National University Bundang Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* 18-80 yrs old * Right-handed * Radiologically confirmed left hemisphere stroke * Fluent in Korean * First ever stroke * More than 1 year from stroke onset * Non-fluent (motor-dominant) aphasia * Written informed consent
Exclusion criteria
* Previous medical histories of stroke, cerebral vascular operation, seizure * Patients with traumatic brain injury * Unable to perform the language task * Severe cognitive impairment (MMSE less than 16) * Skin lesion in the stimulation site of scalp * Metal implants in the body (cardiac pacemaker or aneurysm clip) * Pregnancy, Breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| BNT (Boston naming test) | Before rTMS(baseline), after the completion of 10 session of treatment (rTMS+speech therapy), 2 weeks later after the completion of 10 session of treatment (rTMS+speech therapy) | speech evaluation tool for measuring the confrontational word retrieval function |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| WAB (Western aphasia battery) | Before rTMS(baseline), after the completion of 10 session of treatment (rTMS+speech therapy), 2 weeks later after the completion of 10 session of treatment (rTMS+speech therapy) | speech evaluation tool for screening the presence, degree, and type of aphaisa |
| Laterality index (LI) | Before rTMS(baseline), after the completion of 10 session of treatment (rTMS+speech therapy), 2 weeks later after the completion of 10 session of treatment (rTMS+speech therapy) | From fNIRS findings, LI=L-R/L+R (L and R represent maximum or mean left and Right hemisphereic Hbo values, respectively) |
Countries
South Korea
Outcome results
None listed