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Elements of propositional speech (cookie theft) pre-and postTMS+mCILT (black bars) for P1 (mild-moderate nonfluent aphasia) for A) total number of narrative words, and B) number of different nouns. Previous scores are also shown when intervention was TMS alone (gray bars). *=+2 SD above Baseline.
Source publication
Purpose:
The purpose of this study was to investigate: 1) the feasibilty of administering a modified CILT (mCILT) treatment session immediately after TMS; and 2) if this combined therapy could improve naming and elicited propositional speech in chronic, nonfluent aphasia.
Methods:
Two chronic stroke patients with nonfluent aphasia (mild-moderate...
Contexts in source publication
Context 1
... the BDAE cookie theft picture description, his pre-TMS+mCILT Baseline mean for longest uninter- rupted phrase length was 10.67 (SD, 4.16), and at 2 months post-TMS+mCILT it remained 10. However, there were some quantitative and qualitative differ- ences in his utterances. P1 had a significant increase in the total number of narrative words produced, from a pre-TMS+mCILT Baseline mean of 46 (SD, 5.57), to a 2 month post-TMS+mCILT total of 59 ( Fig. 4A and Table 2). He also had a significant increase in number of different nouns produced from a pre-TMS+mCILT Baseline mean of 7.67 (SD, 1.15), to a 2 month post- TMS+mCILT total of 12 ( Fig. 4B and Table 5A). P1 showed no significant increase in the number of dif- ferent verbs produced post-TMS+mCILT (Table 5A). At 16 months post-TMS+mCILT he showed no lasting change in his utterances, including number of narrative words, or number of different nouns ...
Context 2
... the BDAE cookie theft picture description, his pre-TMS+mCILT Baseline mean for longest uninter- rupted phrase length was 10.67 (SD, 4.16), and at 2 months post-TMS+mCILT it remained 10. However, there were some quantitative and qualitative differ- ences in his utterances. P1 had a significant increase in the total number of narrative words produced, from a pre-TMS+mCILT Baseline mean of 46 (SD, 5.57), to a 2 month post-TMS+mCILT total of 59 ( Fig. 4A and Table 2). He also had a significant increase in number of different nouns produced from a pre-TMS+mCILT Baseline mean of 7.67 (SD, 1.15), to a 2 month post- TMS+mCILT total of 12 ( Fig. 4B and Table 5A). P1 showed no significant increase in the number of dif- ferent verbs produced post-TMS+mCILT (Table 5A). At 16 months post-TMS+mCILT he showed no lasting change in his utterances, including number of narrative words, or number of different nouns ...
Citations
... A study combined rTMS with CIAT, and compared to CIAT, found no additional effect of rTMS (89). Nevertheless, previous studies have found that both of CIAT and CIAT combined with rTMS could improve naming (90,91). The results of the studies may be related to the small sample size, and further research is needed to determine whether it is necessary to combine rTMS based on CIAT. ...
Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders, which may reduce the quality of life among the patients. Constraint-induced therapy has been proven to be an effective treatment method for stroke rehabilitation. It has been widely used in the recovery of limb motor dysfunction, aphasia, and other impairment like unilateral neglect after stroke. In recent years, constraint-induced therapy can also combine with telehealth and home rehabilitation. In addition, constraint-induced therapy produces significant neuroplastic changes in the central nervous system. Functional magnetic resonance imaging, diffusion tensor imaging, and other imaging/electrophysiology methods have been used to clarify the mechanism and neuroplasticity. However, constraint-induced therapy has some limitations. It can only be used under certain conditions, and the treatment time and effectiveness are controversial. Further research is needed to clarify the mechanism and effectiveness of CI therapy.
... Despite the differences between therapies, evidence suggests they are equally efficacious in improving speech production (Rose et al., 2013;Zhang et al., 2017). A case study of two individuals with aphasia who were selected for their strong response to treatment of rTMS alone, without SLT, examined the combination of rTMS and intensive SLT and observed significant improvements in speech production (Martin et al., 2014). More recently, a small (n = 17) shamcontrolled trial of inhibitory rTMS plus ILAT found an overall improvement in speech production but failed to demonstrate an added benefit of rTMS (Heikkinen et al., 2019). ...
... Alternatively, it may be the case that TMS stimulation may be more effective for a particular phenotype. This can be highlighted by a previous study that selected their participants on the basis of responding positively to prior rTMS treatment (Martin et al., 2014). Moreover, in the case of very large left hemisphere lesions with little or no spared frontotemporal cortex, it may be more appropriate to facilitate right IFG activity rather than suppress it. ...
Repetitive transcranial magnetic stimulation (rTMS) shows promise in improving speech production in post-stroke aphasia. Limited evidence suggests pairing rTMS with speech therapy may result in greater improvements. Twenty stroke survivors (>6 months post-stroke) were randomized to receive either sham rTMS plus multi-modality aphasia therapy (M−MAT) or rTMS plus M−MAT. For the first time, we demonstrate that rTMS combined with M−MAT is feasible, with zero adverse events and minimal attrition. Both groups improved significantly over time on all speech and language outcomes. However, improvements did not differ between rTMS or sham. We found that rTMS and sham groups differed in lesion location, which may explain speech and language outcomes as well as unique patterns of BOLD signal change within each group. We offer practical considerations for future studies and conclude that while combination therapy of rTMS plus M−MAT in chronic post-stroke aphasia is safe and feasible, personalized intervention may be necessary.
... Transcranial magnetic stimulation (TMS) has been used in medicine for several decades. It is a non-invasive method affecting the excitability of the cerebral cortex, owing to which it has gained increasing attention as a therapeutic tool in a wide spectrum of neuropsychiatric disorders [19][20][21][22][23]. Low-frequency repetitive transcranial magnetic stimulation (rTMS), e.g., 1 Hz, effectively reduces cortical activity, especially in the areas of increased excitability. ...
Background: The aim of the study was to evaluate the effectiveness of subjective tinnitus treatment in patients with cochlear sensorineural hearing loss with magnetic ear stimulation using a prototype device. Since the 1970s, studies have been conducted on the use of electrical stimulation of the ear in the treatment of tinnitus. The available literature contains various hypotheses about the influence of electrical stimulation of the ear on tinnitus. Material and Methods: Preclinical studies were performed for 100 patients, 40 women and 60 men (124 ears in total), aged 38–72 years, treated for tinnitus. A subjective assessment of the loudness of tinnitus was performed, and the frequency and intensity as well as hearing threshold were determined using a prototype device for electro-magnetic stimulation of the ear. The treatment cycle consisted of 10 five-minute stimulations performed daily 5 times a week. Results: Before treatment, persistent tinnitus was found in 100 ears (80.6%) and periodic tinnitus in 24 ears (19.4%). Immediately after treatment, persistent tinnitus was present only in 50 ears (40.3%) and periodic tinnitus in 40 ears (32.3%). Complete resolution of tinnitus was noted in 34 ears (27.4%). On the other hand, the examination performed 3 months after the treatment showed persistent tinnitus in 40 ears (32.3%) and periodic tinnitus in 50 ears (40.3%), and complete resolution of tinnitus was recorded in 34 ears (27.4%). Based on the VAS analog scale, there was an improvement in tinnitus in 98 ears (79.0%) immediately after treatment and no improvement in 26 ears (20.0%). The mean VAS scale before treatment was 4.9 points, after treatment it was 2.1 points and 3 months after treatment it was 1.9 points. Conclusions: The preliminary research results show the high effectiveness of magnetic stimulation in the treatment of tinnitus with the use of a prototype device for electromagnetic stimulation of the ear. There was no negative effect of the stimulation on hearing or tinnitus.
... Indeed, these studies are highly variable in the extent to which they constrain gesture and often not well described (Pierce et al., 2017). Some studies prohibited gesture use (Pulvermüller et al., 2001) and even strictly enforced spoken language by asking patients to sit on their hands if necessary (Maher et al., 2006;Kirmess and Maher, 2010;Martin et al., 2014). Others allowed gesture use as long as it was used to facilitate verbal language output (i.e., for self-cueing; Meinzer et al., 2007a,b;Difrancesco et al., 2012;Wilssens et al., 2015;Ciccone et al., 2016;Nickels and Osborne, 2016). ...
When people talk, they gesture. Gesture is a fundamental component of language that contributes meaningful and unique information to a spoken message and reflects the speaker’s underlying knowledge and experiences. Theoretical perspectives of speech and gesture propose that they share a common conceptual origin and have a tightly integrated relationship, overlapping in time, meaning, and function to enrich the communicative context. We review a robust literature from the field of psychology documenting the benefits of gesture for communication for both speakers and listeners, as well as its important cognitive functions for organizing spoken language, and facilitating problem-solving, learning, and memory. Despite this evidence, gesture has been relatively understudied in populations with neurogenic communication disorders. While few studies have examined the rehabilitative potential of gesture in these populations, others have ignored gesture entirely or even discouraged its use. We review the literature characterizing gesture production and its role in intervention for people with aphasia, as well as describe the much sparser literature on gesture in cognitive communication disorders including right hemisphere damage, traumatic brain injury, and Alzheimer’s disease. The neuroanatomical and behavioral profiles of these patient populations provide a unique opportunity to test theories of the relationship of speech and gesture and advance our understanding of their neural correlates. This review highlights several gaps in the field of communication disorders which may serve as a bridge for applying the psychological literature of gesture to the study of language disorders. Such future work would benefit from considering theoretical perspectives of gesture and using more rigorous and quantitative empirical methods in its approaches. We discuss implications for leveraging gesture to explore its untapped potential in understanding and rehabilitating neurogenic communication disorders.
... A further eight articles meeting inclusion criteria were identified by searching bibliographies of the included studies. A total of 112 papers are included in this review (Appendix 1) (Abo et al., 2012;Aerts et al., 2015;Bakheit et al., 2007;Barthel et al., 2008;Berthier et al., 2009Berthier et al., , 2017Biran & Fisher, 2015;Bose, 2013;Breitenstein et al., 2015Breitenstein et al., , 2017Brookshire et al., 2014;Carpenter & Cherney, 2016;Carragher et al., 2013Carragher et al., , 2015Cherney, 2010Cherney, , 2012Cherney et al., 1986Cherney et al., , 2012Cherney et al., , 2019Ciccone et al., 2016;Conley & Coelho, 2003;Conroy & Scowcroft, 2012;Conroy et al., 2009;Cotelli et al., 2011;Crerar et al., 1996;Cunningham & Ward, 2003;DeDe et al., 2019;Dignam et al., 2016a;Dignam et al., 2015;Duncan & Small, 2017, 2018Faroqi-Shah & Virion, 2009;Fillingham et al., 2005;Floel et al., 2011;Furnas & Edmonds, 2014;Galling et al., 2014;Godecke et al., 2012Godecke et al., , 2014Goodkin, 1969;Goral & Kempler, 2009;Gravier et al., 2018;Griffith et al., 2017;Harnish et al., 2008Harnish et al., , 2013Harnish et al., , 2018Hartman & Landau, 1987;Helmick & Wipplinger, 1975;Herbert et al., 2012;Hough, 2010;Hough & Johnson, 2009;Kaviani et al., 2018;Kim & Lemke, 2016;Kirmess & Lind, 2011;Kirmess & Maher, 2010;Knollman-Porter et al., 2018;Koyuncu et al., 2016;Krajenbrink et al., 2017;Kristensen et al., 2015;Kurland et al., 2010Kurland et al., , 2012Kurland et al., , 2018Lee et al., 2009Lee et al., , 2018Lucchese et al., 2017;Maher et al., 2006;Marcotte et al., 2018;Marshall et al., 2013Marshall et al., , 2016Martin et al., 2014;Martins et al., 2013;Meinzer et al., 2004Meinzer et al., , 2005Meinzer et al., , 2008Mozeiko et al., 2016Mozeiko et al., , 2018Munro & Siyambalapitiya, 2017;Newton et al., 2017;Nickels & Osborne, 2016;Nouwens et al., 2017;Nykänen et al., 2013;Off et al., 2016;Palmer et al., 2019;Peach, 2002;Peach & Reuter, 2010;Poeck et al., 1989;Pulvermuller et al., 2001;Ramsberger & Marie, 2007;Raymer et al., 2006;Richardson et al., 2015;Rieu et al., 2001;Rodriguez et al., 2013;Rogalski et al., 2013;Romani et al., 2019;Rose & Sussmilch, 2008;Rubin & Bollinger, 1983;Sage et al., 2011;Sickert et al., 2014;Snell et al., 2010;Stadie et al., 2008;Stahl et al., 2013Stahl et al., , 2016Stahl et al., , 2018Stark & Warburton, 2018;Thiel et al., 2016;van Hees et al., 2014;Vuksanović et al., 2018;Wallace & Kayode, 2017;Wenke Wieczorek et al., 2011;Woldag et al., 2017;Yamada et al., 2016). A subgroup of 14 papers emerged which examined dose-response relationships by comparing the administration of different amounts of the same intervention across groups or individuals (Appendix 2) (Bakheit et al., 2007;Breitenstein et al., 2017;Carpenter & Cherney, 2016;Cherney, 2012;DeDe et al., 2019;Gravier et al., 2018;Harnish et al., 2013;Herbert et al., 2012;Lee et al., 2009;Marshall et al., 2013;Mozeiko et al., 2018;Off et al., 2016;Snell et al., 2010;Stahl et al., 2018). ...
Little is known about how the amount of treatment a person with aphasia receives impacts aphasia recovery following stroke, yet this information is vital to ensure effective treatments are delivered efficiently. Furthermore, there is no standard dose terminology in the stroke rehabilitation or aphasia literature. This scoping review aims to systematically map the evidence regarding dose in treatments for post-stroke aphasia and to explore how treatment dose is conceptualized, measured and reported in the literature. A comprehensive search was undertaken in June 2019. One hundred and twelve intervention studies were reviewed. Treatment dose (amount of treatment) has been conceptualized as both a measure of time and a count of discrete therapeutic elements. Doses ranged from one to 100 hours, while some studies reported session doses of up to 420 therapeutic inputs per session. Studies employ a wide variety of treatment schedules (i.e., session dose, session frequency, and intervention duration) and the interaction of dose parameters may impact the dose–response relationship. High dose interventions delivered over short periods may improve treatment efficiency while maintaining efficacy. Person- and treatment-level factors that mediate tolerance of high dose interventions require further investigation. Systematic exploration of dose–response relationships in post-stroke aphasia treatment is required.
... 7. Esquema de tratamiento en la afasia. El protocolo de tratamiento de la afasia que hemos empezado a utilizar en la Clínica San Vicente está basado en el protocolo desarrollado por el Berenson-Allen Center for Noninvasive Brain Stimulation (BIDMC) de Boston, dirigido por Álvaro Pascual-Leone, el cual tiene como base de sustentación científica los diferentes trabajos de investigación llevados a cabo por Naeser et al. [118][119][120][121][122] . Consiste en 10 sesiones de EMTr (una sesión diaria durante los 10 días laborables de 2 semanas) de 20 min, seguidas de tratamiento logopédico intensivo (1 h diaria aproximadamente). ...
Introduction
A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS).
Methods
We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS.
Conclusions
Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
... The vast majority of published studies have examined the inhibitory effects of rTMS in stroke patients by applying low-frequency 1 Hz stimulation to the intact homologous areas of the RH in the inferior frontal gyrus (IFG) (Abo et al., 2012;Barwood et al., 2011Barwood et al., , 2012Barwood et al., , 2013Garcia, Norise, Faseyitan, Naeser, & Hamilton, 2013;Hamilton et al., 2010;Heiss et al., 2013;Martin et al., 2009Martin et al., , 2014Medina et al., 2012;Naeser et al., 2005Naeser et al., , 2011Naeser et al., , 2012Schlaug et al., 2011;Thiel et al., 2013;Tsai et al., 2014;Wang et al., 2014;Weiduschat et al., 2010;Winhuisen et al., 2005; (for a review see Li, Qu, Yuan, & Du, 2015;Otal et al., 2015;Ren et al., 2014)), while fewer studies have used high-frequency (≥3 to 20 Hz) rTMS applied to the LH, to investigate whether stimulating perilesional regions can boost recovery (Dammekens, Vanneste, Ost, & De Ridder, 2014;Khedr et al., 2014;Schlaug et al., 2011), probably due to the fact that the safety of the former is higher in this population compared to high-frequency rTMS. Note that there are also studies that combine low-and high-frequency stimulation in an attempt to maximize the effectiveness of treatment (Chieffo et al., 2014;Hu et al., 2018;Kakuda, Abo, Momosaki, & Morooka, 2011). ...
Behavioral therapy techniques applied to patients with aphasia have recently been augmented with or replaced by repetitive transcranial magnetic stimulation (rTMS). This chapter reviews recent studies employing rTMS as a therapeutic technique for patients with aphasia. More specifically, it focuses on issues concerning the effectiveness of the rTMS technique, including the stimulation parameters as well as the combined use of rTMS with speech and language therapy. Furthermore, it discusses improvements in specific language domains following intervention with rTMS. In addition, it briefly discusses the effectiveness of theta-burst stimulation (TBS), a type of rTMS. Finally, it raises issues concerning methodological limitations of the current rTMS studies on aphasia rehabilitation.
... The vast majority of published studies have examined the inhibitory effects of rTMS in stroke patients by applying low-frequency 1 Hz stimulation to the intact homologous areas of the RH in the inferior frontal gyrus (IFG) (Abo et al., 2012;Barwood et al., 2011Barwood et al., , 2012Barwood et al., , 2013Garcia, Norise, Faseyitan, Naeser, & Hamilton, 2013;Hamilton et al., 2010;Heiss et al., 2013;Martin et al., 2009Martin et al., , 2014Medina et al., 2012;Naeser et al., 2005Naeser et al., , 2011Naeser et al., , 2012Schlaug et al., 2011;Thiel et al., 2013;Tsai et al., 2014;Wang et al., 2014;Weiduschat et al., 2010;Winhuisen et al., 2005; (for a review see Li, Qu, Yuan, & Du, 2015;Otal et al., 2015;Ren et al., 2014)), while fewer studies have used high-frequency (≥3 to 20 Hz) rTMS applied to the LH, to investigate whether stimulating perilesional regions can boost recovery (Dammekens, Vanneste, Ost, & De Ridder, 2014;Khedr et al., 2014;Schlaug et al., 2011), probably due to the fact that the safety of the former is higher in this population compared to high-frequency rTMS. Note that there are also studies that combine low-and high-frequency stimulation in an attempt to maximize the effectiveness of treatment (Chieffo et al., 2014;Hu et al., 2018;Kakuda, Abo, Momosaki, & Morooka, 2011). ...
This edited volume provides the first presentation of the state-of-the-art in the application of modern Neuroscience research in predicting, preventing and alleviating the negative sequelae of neurodevelopmental, acquired, or neurodegenerative conditions on speech and language. It brings together contributions from several leading experts in a markedly broad range of disciplines, including Speech and Language Therapy, Neuropsychology and Neurology, but also Neurosurgery, Neuroimaging and Neurostimulation, as well as Engineering and Genetics.
... rTMS) or pharmacological treatments (e.g., memantine) in combination with constraint or multimodal therapies. Two of these were RCTs (Barbancho et al., 2015;Berthier et al., 2009), one a SCED (Al-Janabi et al., 2014) and three were pre/post designs (Abo et al., 2012;Martin et al., 2014;Vines, Norton, & Schlaug, 2011). While results of these mixed treatments were broadly positive, the contribution of the constraint and multimodal therapies could not be differentiated from the pharmacological and stimulation treatment aspects. ...
... The way "constraint" was applied varied considerably and was not well described in many studies. While all studies constrained communication between participants to the verbal modality only, three studies explicitly prevented participants from using gestures to self-cue (Breier, Maher, Novak, & Papanicolaou, 2006;Martin et al., 2014) whereas five studies allowed such gesture MacGregor, Difrancesco, Pulvermüller, Shtyrov, & Mohr, 2015;Meinzer, Streiftau, & Rockstroh, 2007;Mohr, Difrancesco, Harrington, Evans, & Pulvermüller, 2014). The remaining 19 did not specify whether they allowed self-cueing or not, including the original CIAT paper (Pulvermüller et al., 2001). ...
Background: Human communication is essentially multimodal however verbal approaches and techniques have traditionally dominated behavioural aphasia therapies. These verbal techniques are the hallmark of constraint-induced aphasia interventions (Rose, M. L. (2013). Releasing the constraints on aphasia therapy: The positive impact of gesture and multimodality treatments. American Journal of Speech-Language Pathology, 22, S227–S239. doi:10.1044/1058-0360(2012/12-0091). Recent evidence reveals both the considerable gesture abilities of people with aphasia and the complex, interacting neural networks that underpin verbal and nonverbal communication (Rose, M. L. (2013). Releasing the constraints on aphasia therapy: The positive impact of gesture and multimodality treatments. American Journal of Speech-Language Pathology, 22, S227–S239. doi:10.1044/1058-0360(2012/12-0091). It is possible that such nonverbal abilities may be positively harnessed in aphasia therapy that is aimed at improving spoken communication, through explicit cueing of nonverbal elements to facilitate word retrieval and/or support language re-learning. The principles of neuroplasticity, including “use it or lose it” (and associated concepts of learned non-use), specificity, salience, transference, and interference, are largely derived from animal motor system models. These principles require careful interpretation when applied to rehabilitation of human language and cognition. Currently, clinicians have little guidance about whether to focus on multimodal cueing in their aphasia therapies or to restrict cueing, activity, and practice to the verbal modality consistent with constraint approaches.
Aim: We aimed to investigate the comparative evidence for constraint and multimodal aphasia therapies for changes in language, communication, quality of life, and carer burden outcomes in people with post-stroke aphasia.
Methods and Procedures: We systematically reviewed the literature on constraint and multimodal aphasia therapies (Pierce, J., Menahemi-Falkov, M., O’Halloran, R., Togher, L., & Rose, M. (2017). Constraint and multimodal approaches to therapy for chronic aphasia. A systematic review and meta-analysis. Neuropsychological Rehabilitation, 2017. doi:10.1080/09602011.2017.1365730). Databases were searched in September 2015 without date restriction. We included randomised controlled trials (RCT), parallel group, and single subject design studies. Studies included in two recent related systematic reviews (Brady, M. C., Kelly, H., Godwin, J., Enderby, P., & Campbell, P. (2016). Speech and language therapy for aphasia following stroke. The Cochrane Database of Systematic Reviews, 6, CD000425–CD000425. doi:10.1002/14651858.CD000425.pub4; Zhang et al., 2017) were added to the original yield. Studies meeting inclusion criteria were rated for quality on the PEDro-P scale for RCTs and non-randomised trials, and the RoBiNT scale for single-subject experimental designs. Effect sizes were calculated and compared for studies exceeding quality thresholds (≥5 PEDro-P; ≥12 RoBiNT).
Outcomes and results: From the yield of 1251 non-duplicate citations, 62 articles met inclusion/exclusion criteria for quality review and synthesis. Of these 16 multimodal and 7 constraint studies were eligible for synthesis. Overall, positive effects were demonstrated on linguistic outcomes for both constraint and multimodal therapies, however neither approach was superior. There was limited or no evidence for measures of communication, quality of life, and carer burden.
Conclusions: The current evidence does not support the superiority of constraint over multimodal therapies for people with chronic post-stroke aphasia. The small number of studies that directly compare constraint and multimodal treatments, their small Ns, and the low quality of many of these studies means that the findings of this review are based on a very limited evidence base. Further, the term “constraint” currently encompasses therapies with significant procedural differences. Clearer reporting of methods is required to prevent the risk of application of the term “constraint” to a highly diverse range of game-based and linguistic treatments. In order to address these study limitations, we commenced the COMPARE RCT (Rose et al, in preparation). Constraint induced or multi-modal personalised aphasia rehabilitation (COMPARE). A randomised controlled trial for stroke related chronic aphasia.). COMPARE aims to provide high-quality trial evidence for the relative efficacy of constraint and multimodal approaches to aphasia therapy, taking into consideration participant linguistic and cognitive factors that may impact treatment response. The COMPARE trial is a 3-arm PROBE design RCT comparing constraint-induced aphasia therapy, multimodality aphasia therapy, and usual care in 216 people with chronic post-stroke aphasia. Primary outcome is immediately following intervention with a follow-up time point at 12 weeks following intervention. A nested sub-study examines the impact of an intensive (30 h in 2 weeks) versus less intensive (30 h in 5 weeks) dose. The cost-effectiveness of the interventions is being investigated.
... In patients with stroke, high-frequency rTMS ( [118][119][120][121][122] Our protocol consists of 10 to 20-min sessions of rTMS (one session daily, Monday to Friday for 2 weeks), followed by intensive speech therapy (approximately 1 h per day). We apply 1-Hz rTMS to the intact, right hemisphere to reduce its potential inhibition of the Broca area of the damaged, left hemisphere. ...
Introduction
Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain's capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills.
Development
We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations.
Conclusions
Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomised controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.
