Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia : A Randomized Controlled Trial

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Heikkinen , P H , Pulvermüller , F , Mäkelä , J P , Ilmoniemi , R J , Lioumis , P , Kujala , T , Manninen , R-L , Ahvenainen , A & Klippi , A 2019 , ' Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia : A Randomized Controlled Trial ' , Frontiers in Neuroscience , vol. 12 , 1036 . https://doi.org/10.3389/fnins.2018.01036

Title: Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia : A Randomized Controlled Trial
Author: Heikkinen, Paula H.; Pulvermüller, Friedemann; Mäkelä, Jyrki P.; Ilmoniemi, Risto J.; Lioumis, Pantelis; Kujala, Teija; Manninen, Riitta-Leena; Ahvenainen, Antti; Klippi, Anu
Contributor: University of Helsinki, Medicum
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, Aalto University
University of Helsinki, University of Toronto
University of Helsinki, Department of Psychology and Logopedics
University of Helsinki, Medicum
Date: 2019-02-04
Language: eng
Number of pages: 13
Belongs to series: Frontiers in Neuroscience
ISSN: 1662-453X
URI: http://hdl.handle.net/10138/300037
Abstract: Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex-that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study.
Subject: chronic aphasia
language rehabilitation
efficacy
ILAT
rTMS
randomized controlled trial (RCT)
TRANSCRANIAL MAGNETIC STIMULATION
CONSTRAINT-INDUCED APHASIA
LOW-FREQUENCY RTMS
NONFLUENT APHASIA
CORTICAL EXCITABILITY
POSTSTROKE APHASIA
BRAIN-STIMULATION
CHRONIC STROKE
RECOVERY
NEUROSCIENCE
515 Psychology
6162 Cognitive science
6163 Logopedics
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