To determine to what extent repetitive transcranial magnetic stimulation (rTMS) combined with speech and language therapy improves functional communication and basic linguistic skills of individuals with subacute aphasia.
Randomized, blinded, and sham-controlled study.
Neurologic rehabilitation hospital.
Participants (N=30) with subacute aphasia after stroke.
During a 2-week treatment period, half of the participants received 10 sessions of 20-minute inhibitory 1-Hz rTMS over the right inferior frontal gyrus (Brodmann area 45), and the other half received sham stimulation. Directly thereafter, all the participants underwent 45 minutes of speech and language therapy.
Main Outcome Measures
Aachen Aphasia Test, Amsterdam-Nijmegen Everyday Language Test (ANELT), a naming screening, and subscales of the FIM, all assessed the day before and the day after treatment period.
The participants who received real rTMS significantly improved with respect to all 10 measures of basic linguistic skills and functional communication, whereas sham-treated participants significantly improved in only 6 of 10 measures (paired t tests, P<.05). There was a significant difference in the gains made by the 2 groups on 5 of 10 measures including functional communication (ANELT) (repeated-measures analysis of variance, P≤.05).
For the first time, this study has demonstrated that basic linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral language therapy in patients with subacute aphasia.
List of abbreviations:AAT (Aachen Aphasia Test), ANELT (Amsterdam-Nijmegen Everyday Language Test), ANOVA (analysis of variance), MRI (magnetic resonance imaging), SLT (speech and language therapy), rTMS (repetitive transcranial magnetic stimulation)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study.Brain Lang. 2005; 93: 95-105
- The effects of low frequency repetitive transcranial magnetic stimulation (rTMS) and sham condition rTMS on behavioral language in chronic non-fluent aphasia: short term outcomes.NeuroRehabilitation. 2011; 28: 113-128
- Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation.Brain Lang. 2011; 118: 40-50
- Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation.Front Hum Neurosci. 2013; 7: 1-17
- Stimulating language: insights from TMS.Brain. 2007; 130: 610-622
- Interhemispheric compensation: a hypothesis of TMS-induced effects on language-related areas.Eur Psychiatry. 2008; 23: 281-288
- Noninvasive brain stimulation in the treatment of aphasia: exploring interhemispheric relationships and their implications for neurorehabilitation.Restor Neurol Neurosci. 2011; 29: 375-394
- Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation.Brain Stimul. 2008; 1: 326-336
- TMS and tCDS in post-stroke aphasia: integrating novel treatment approaches with mechanisms of plasticity.Restor Neurol Neurosci. 2013; 31: 501-515
- Transcranial magnetic stimulation as a complementary treatment for aphasia.Semin Speech Lang. 2004; 25: 181-191
- Overt naming fMRI pre- and post-TMS: two nonfluent aphasia patients, with and without improved naming post-TMS.Brain Lang. 2009; 11: 20-35
- Research with rTMS in the treatment of aphasia.Restor Neurol Neurosci. 2010; 28: 511-529
- Stimulating conversation: enhancement of elicited propositional speech in a patient with chronic nonfluent aphasia following transcranial magnetic stimulation.Brain Lang. 2010; 113: 45-50
- Improved receptive and expressive language abilities in nonfluent aphasic stroke patients after application of rTMS: an open protocol case series.Brain Stimul. 2012; 5: 274-286
- Finding the right words: transcranial magnetic stimulation improves discourse productivity in non-fluent aphasia after stroke.Aphasiology. 2012; 26: 1153-1168
- Effectiveness of low-frequency rTMS and intensive speech therapy in poststroke patients with aphasia: a pilot study based on evaluation by fMRI in relation to type of aphasia.Eur Neurol. 2012; 68: 199-208
- Dynamics of language reorganization after stroke.Brain. 2006; 129: 1371-1384
- A proposed regional hierarchy in recovery of post-stroke aphasia.Brain Lang. 2006; 98: 118-123
- Recovery of semantic word processing in transcortical sensory aphasia: a functional magnetic resonance imaging study.Neurocase. 2002; 8: 376-386
- Neural correlates of recovery from aphasia after damage to left inferior frontal cortex.Neurology. 2000; 55: 1883-1894
- The right hemisphere is not unitary in its role in aphasia recovery.Cortex. 2012; 48: 1179-1186
- Distinct mechanisms and timing of language recovery after stroke.Cogn Neuropsychol. 2013; 30: 454-475
- Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation: a randomized double-blind controlled pilot study.Top Stroke Rehabil. 2013; 20: 250-261
- Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients: a prospective, randomized, double-blind sham-controlled study.ScientificWorldJournal. 2012; 2012: 518568
- Theta burst stimulation over the right Broca's homologue induces improvement of naming in aphasic patients.Stroke. 2012; 43: 2175-2179
- Effects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study.Stroke. 2011; 42: 409-415
- Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia.Stroke. 2013; 44: 2240-2246
- Noninvasive brain stimulation for treatment of right- and left-handed poststroke aphasics.Cerebrovasc Dis. 2013; 36: 363-372
- Dual-hemisphere repetitive transcranial magnetic stimulation for rehabilitation of poststroke aphasia: a randomized, double-blind clinical trial.Neurorehabil Neural Repair. 2014; 28: 740-750
- Aachen Aphasia Test (AAT).Hogrefe, Göttingen1983
- Problems in the assessment of hand preference.Cortex. 1985; 21: 533-549
- A standardized set of 260 pictures: norms for name agreement, image agreement, familiarity, and visual complexity.J Exp Psychol Hum Learn. 1980; 6: 174-215
- Amsterdam-Nijmegen Everyday Language Test (ANELT).Swets Test Services, Lisse1997
- Efficacy of early cognitive-linguistic treatment and communicative treatment in aphasia after stroke: a randomized controlled trial (RATS-2).J Neurol Neurosurg Psychiatry. 2011; 82: 399-404
- Performance profiles of the Functional Independence Measure.Am J Phys Med Rehabil. 1993; 72: 84-89
- Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996.Electroencephalogr Clin Neurophysiol. 1998; 108: 1-16
- Localizing Broca’s area for transcranial magnetic stimulation: comparison of surface distance measurements and stereotaxic positioning.Brain Stimul. 2009; 2: 93-102
- Decreasing and increasing cues in naming therapy for aphasia.Aphasiology. 2005; 19: 831-848
- ELA Everyday life activities. Set 1-3 photo series.Psychology Pr, New York1994
- Therapeutic approaches in aphasia rehabilitation.in: Stemmer B. Whitaker H.A. Handbook of the neuroscience of language. 1st ed. Elsevier, London2008: 397-406
- From singing to speaking: why singing may lead to recovery of expressive language function in patients with Broca’s aphasia.Music Percept. 2008; 25: 315-323
- power primer.Psychol Bull. 1992; 112: 155-159
- TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia.Brain Lang. 2011; 119: 206-213
- Effects of semantic treatment on verbal communication and linguistic processing in aphasia after stroke. A randomized controlled trial.Stroke. 2004; 35: 141-146
- Direct demonstration of transcallosal disinhibition in language networks.J Cereb Blood Flow Metab. 2006; 26: 1122-1127
- Localizing interference during naming: convergent neuroimaging and neuropsychological evidence for the function of Broca's area.Proc Natl Acad Sci U S A. 2008; 106: 322-327
- Role of left inferior prefrontal cortex in retrieval of semantic knowledge: a reevaluation.Proc Natl Acad Sci U S A. 1997; 94: 14792-14797
- Phonological processing during language production: fMRI evidence for a shared production-comprehension network.Brain Res Cogn Brain Res. 2003; 16: 285-296
- The brain basis of language processing: from structure to function.Physiol Rev. 2011; 9: 1357-1392
- Ventral and dorsal pathways for language.Proc Natl Acad Sci U S A. 2008; 105: 18035-18040
- Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language.Cognition. 2004; 92: 67-99
- A meta-analysis of clinical outcomes in the treatment of aphasia.J Speech Lang Hear Res. 1998; 41: 172-187
Published online: July 16, 2015
Supported in part by the Walter and Marga Boll Foundation and the Wolf-Dieter Heiss-Foundation.
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.