Aphasia
Conditions
Keywords
chronic aphasia, rehabilitation, randomized controlled trial (RCT)
Brief summary
With the present RCT, the investigators aimed at finding an optimal protocol for the neurorehabilitation of chronic post-stroke aphasia by combining two promising methods, ILAT (Intensive language action therapy) and 1-Hz rTMS to the right-hemispheric homologue of the anterior language area of Broca (pars triangularis), thus taking advantage of recent research in speech and language sciences, neurorehabilitation and brain research.
Detailed description
New neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included. Combined with behavioral techniques, Intensive Language-Action Therapy (ILAT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone. In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage will be studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex (pars triangularis). Participant will be randomized to groups A and B. Participants in group A will receive a 2-week period of rTMS during naming training where they name pictures every ten second displayed on the screen, followed by 2-weeks of rTMS and naming combined with ILAT. Those in group B will receive the same behavioral therapy but TMS is replaced by sham stimulation. Language performance will be measured before, during and after the interventions for 3 months.
Interventions
BEHAVIORALIntensive Language-Action Therapy (ILAT)
ILAT includes communicative language games played in an interactive small-group setting. Three persons with aphasia and one therapist sit around a table and have picture cards in front of them. The card sets include two items of each object or action picture. All participants take turns in making verbal requests. There will be 5 daily sessions (3 hours per session) for two weeks.
DEVICERepetitive navigated Transcranial Magnetic Stimulation during naming training
Magnetic stimulation will delivered with a figure-of-eight cooled coil of Navigated Brain Stimulation System during picture naming training. The primary targeted area is the right pars triangularis. In each session, rTMS will be applied at 1-Hz for 20 minutes, 5 daily sessions per week for four weeks.
Sponsors
Hospital District of Helsinki and Uusimaa
Aalto University
Freie Universität Berlin
Paula Heikkinen
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* age between 18 and 75 years * presence of a single clinically documented stroke * chronic stage (at least 12 months post-stroke) * aphasia documented using the WAB test * no recurring utterances or severe global (total) aphasia * residual ability to understand simple task instructions * availability of information about medication * right-handedness * native speakers of Finnish.
Exclusion criteria
* severe global (total) aphasia (Boston naming test less 3 points) * neglect, agnosia, severe vision impairment or hearing loss * severe attention or memory deficits * left-handedness * cardiac pacemaker or other stimulators * diagnosis of severe diabetes or severe depression * additional neurological diagnoses * other interventions, including speech therapy, in the same time period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Western Aphasia Battery | Change in AQ performed at weeks 1 (baseline), 4 and 7 and follow up 3 months after therapy completion | aphasia quotient (AQ) measurement |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Boston naming test | Change in picture naming ability between weeks 1 (baseline), 4 and 7 and follow up 3 months after therapy completion | picture naming ability |
| The Action naming test | Change in picture naming ability between weeks 1 (baseline), 4 and 7 and follow up 3 months after therapy completion | picture naming ability |
Outcome results
None listed