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

Research output: Contribution to journalArticleScientificpeer-review

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.

Original languageEnglish
Article number1036
JournalFrontiers in Neuroscience
Volume12
Number of pages13
ISSN1662-453X
DOIs
Publication statusPublished - 4 Feb 2019
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 3112 Neurosciences
  • 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

Cite this

@article{71cb88c1eea74ed6bb68d68265691de7,
title = "Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial",
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.",
keywords = "3112 Neurosciences, 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",
author = "Heikkinen, {Paula H.} and Friedemann Pulverm{\"u}ller and M{\"a}kel{\"a}, {Jyrki P.} and Ilmoniemi, {Risto J.} and Pantelis Lioumis and Teija Kujala and Anu Klippi",
year = "2019",
month = "2",
day = "4",
doi = "10.3389/fnins.2018.01036",
language = "English",
volume = "12",
journal = "Frontiers in Neuroscience",
issn = "1662-453X",
publisher = "Frontiers Media",

}

TY - JOUR

T1 - Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia

T2 - A Randomized Controlled Trial

AU - Heikkinen, Paula H.

AU - Pulvermüller, Friedemann

AU - Mäkelä, Jyrki P.

AU - Ilmoniemi, Risto J.

AU - Lioumis, Pantelis

AU - Kujala, Teija

AU - Klippi, Anu

PY - 2019/2/4

Y1 - 2019/2/4

N2 - 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.

AB - 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.

KW - 3112 Neurosciences

KW - chronic aphasia

KW - language rehabilitation

KW - efficacy

KW - ILAT

KW - rTMS

KW - randomized controlled trial (RCT)

KW - TRANSCRANIAL MAGNETIC STIMULATION

KW - CONSTRAINT-INDUCED APHASIA

KW - LOW-FREQUENCY RTMS

KW - NONFLUENT APHASIA

KW - CORTICAL EXCITABILITY

KW - POSTSTROKE APHASIA

KW - BRAIN-STIMULATION

KW - CHRONIC STROKE

KW - RECOVERY

KW - NEUROSCIENCE

U2 - 10.3389/fnins.2018.01036

DO - 10.3389/fnins.2018.01036

M3 - Article

VL - 12

JO - Frontiers in Neuroscience

JF - Frontiers in Neuroscience

SN - 1662-453X

M1 - 1036

ER -