Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety.

Chiara Picano,Paola Marangolo,Agnese Quadrini,Francesca Pisano

doi:10.3390/brainsci11010041

Chiara Picano, Paola Marangolo + Show 2 more

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https://doi.org/10.3390/brainsci11010041

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Abstract

Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.

Highlights

Aphasia is an acquired language disorder which occurs in about one-third of people suffering from left-cerebral artery stroke [1,2]
We focused on the use of Transcranial Direct Current Stimulation, both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS
The review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy

Summary

Introduction

Aphasia is an acquired language disorder which occurs in about one-third of people suffering from left-cerebral artery stroke [1,2]. It impairs the person’s ability to process language with heterogeneous symptoms varying in terms of severity and degree of involvement across the different linguistic modalities, including the expression and comprehension of language, reading and writing [3]. Aphasia is one of the most serious socially disabling consequences after stroke. The language impairment determines loss of autonomy and of independence, dramatically compromising social relationships [5]. After an initial spontaneous recovery, most notably during the first 2–3 months following stroke onset, language improvement can occur in response to behavioral training in the chronic phase [6]

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