Post-stroke Aphasic Patients Research Articles

Disrupted Intrinsic Local Synchronization in Poststroke Aphasia.

Evidence has accumulated from the task-related and task-free (i.e., resting state) studies that alternations of intrinsic neural networks exist in poststroke aphasia (PSA) patients. However, information is lacking on the changes in the local synchronization of spontaneous functional magnetic resonance imaging blood–oxygen level-dependent fluctuations in PSA at rest.We investigated the altered intrinsic local synchronization using regional homogeneity (ReHo) on PSA (n = 17) and age- and sex-matched healthy controls (HCs) (n = 20). We examined the correlations between the abnormal ReHo values and the aphasia severity and language performance in PSA.Compared with HCs, the PSA patients exhibited decreased intrinsic local synchronization in the right lingual gyrus, the left calcarine, the left cuneus, the left superior frontal gyrus (SFG), and the left medial of SFG. The local synchronization (ReHo value) in the left medial of SFG was positively correlated with aphasia severity (r = 0.55, P = 0.027) and the naming scores of Aphasia Battery of Chinese (r = 0.66, P = 0.005). This result is consistent with the important role of this value in language processing even in the resting state.The pathogenesis of PSA may be attributed to abnormal intrinsic local synchronous in multiple brain regions.

REHABILITATION OF PATIENTS WITH APHASIA USING MODIFIED RESTORATION METHODS

Backgroud: There is a high prevalence of vascular diseases of the brain in adult population. One of the most severe complications of the cerebral vascular diseases is an aphasia leading to patient’s disability. An extremely severe and unreversible condition for further rehabilitation is noted in a group of patients which develops an impressive speech impairment as a dominant disturbance associated with aphasia. Aim: To identify the most effective rehabilitation method for patients with complications of cerebral circulation disturbances manifesting as speech impairment in a form of aphasia. Materials and methods: Theoretical aspect of rehabilitation in post-stroke aphasia patients with a dominant impressive speech impairment was studied. All patients underwent neurologic examination, dynamic logopedic observation, and magnetic resonance imaging. The patients of the chosen group underwent rehabilitation with a modified modality of speech restoration. Results: Introduction of the modified rehabilitation methods into the logopedics practice proved their high efficiency. Significant improvement was seen in 64% of patients with acoustic-amnestic aphasia, in 57% of patients with acoustic-gnostic aphasia, and in 60% of those with semantic aphasia. Conclusion: A key moment for achievement of the high rehabilitation outcome is a complex approach needed for rehabilitation of patients with the consequences of the acute impairments of cerebral circulation.

Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination.

ObjectiveTo assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients.MethodsMedical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters.ResultsAll subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group.ConclusionAmong subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.

Effects of low-frequency repetitive transcranial magnetic stimulation combined with intensive speech therapy on cerebral blood flow in post-stroke aphasia.

We provided an intervention to chronic post-stroke aphasic patients using low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) guided by a functional magnetic resonance imaging (fMRI) evaluation of language laterality, combined with intensive speech therapy (ST). We performed a single photon emission-computed tomography (SPECT) scan pre- and post-intervention and investigated the relationship between cerebral blood flow (CBF) and language function. Fifty right-handed chronic post-stroke aphasic patients were enrolled in the study. During their 11-day hospital admission, the patients received a 40-min session of 1-Hz LF-rTMS on the left or right hemisphere, according to language localization identified by the fMRI evaluation, and intensive ST daily for 10days, except for Sunday. A SPECT scan and language evaluation by the Standard Language Test of Aphasia (SLTA) were performed at the time of admission and at 3months following discharge. We calculated laterality indices (LIs) of regional CBF (rCBF) in 13 language-related Brodmann area (BA) regions of interest. In patients who received LF-rTMS to the intact right hemisphere (RH-LF-rTMS), the improvement in the total SLTA score was significantly correlated with the pre- and post-intervention change of LI (ΔLI) in BA44. In patients who received LF-rTMS to the lesional left hemisphere (LH-LF-rTMS), this association was not observed. Analyses of the SLTA subscales and rCBF ΔLI demonstrated that in the RH-LF-rTMS group, the SLTA Speaking subscale scores were significantly correlated with ΔLIs in BA11, 20, and 21, and the SLTA Writing subscale scores were significantly correlated with ΔLIs in BA6 and 39. Conversely, in the LH-LF-rTMS group, the SLTA Speaking subscale scores were correlated with ΔLI in BA10, and the SLTA Reading subscale scores were significantly correlated with ΔLIs in BA13, 20, 22, and 44. Our results suggest the possibility that fMRI-guided LF-rTMS combined with intensive ST may affect CBF and contribute to the improvement of language function of post-stroke aphasic patients. LF-rTMS to the non-lesional and lesional hemispheres showed a difference in the associations between language performance and CBF. The results indicate that more effective rTMS intervention needs to be explored for patients who show right hemisphere language activation in an fMRI language evaluation.

Long-Term Effects of Transcranial Direct-Current Stimulation in Chronic Post-Stroke Aphasia: A Pilot Study

Transcranial direct-current stimulation (tDCS) has been suggested to improve language function in patients with post-stroke aphasia. Most studies on aphasic patients, however, were conducted with a very limited follow-up period, if any. In this pilot, single-blind study on chronic post-stroke aphasic patients, we aimed to verify whether or not tDCS is able to extend its beneficial effects for a longer period of time (21 weeks after the end of stimulation). Three aphasic patients underwent anodal tDCS (A-tDCS, 20 min, 1.5 mA) and sham stimulation (S-tDCS) over the left frontal (perilesional) region, coupled with a simultaneous naming training (on-line tDCS). Ten consecutive sessions (5 days per week for 2 weeks) were implemented. In the first five sessions, we used a list of 40 figures, while in the subsequent five sessions we utilized a second set of 40 figures differing in word difficulty. At the end of the stimulation period, we found a significant beneficial effect of A-tDCS (as compared to baseline and S-tDCS) in all our subjects, regardless of word difficulty, although with some inter-individual differences. In the follow-up period, the percentage of correct responses persisted significantly better until the 16th week, when an initial decline in naming performance was observed. Up to the 21st week, the number of correct responses, though no longer significant, was still above the baseline level. These results in a small group of aphasic patients suggest a long-term beneficial effect of on-line A-tDCS.

Proper name anomia in poststroke aphasics: evidence from a multiple-case study

We aimed to characterize difficulties in famous face naming in three poststroke aphasic patients with a lesion limited to the left mid-posterior temporal language regions, sparing the anterior temporal lobe. The patients did not present semantic deficits specific to known people. Nonetheless, they showed difficulties naming famous buildings in addition to famous faces, but they were comparable to healthy controls in generating proper names. Our results support the critical role of the mid-posterior temporal language regions in the lexical retrieval of proper names, namely from pictorial stimuli, in absence of semantic impairments.

Aphasia Severity in Chronic Stroke Patients

Background. The contribution of lesion size and location in poststroke aphasia is debated, especially the extent to which aphasia severity is affected by damage to specific white matter areas. Objective. To identify specific white matter areas critical for poststroke aphasia global severity and to determine whether injury to these areas had more impact on aphasia severity than the infarct volume. Methods. Twenty-three chronic poststroke aphasic patients were assessed with the Aphasia Rapid Test (ART) and the Boston Diagnosis Aphasia Examination (BDAE) global severity scales and underwent diffusion tensor and structural imaging. Voxel-based diffusion tensor imaging regression analysis was used to determine in which areas fractional anisotropy (FA) abnormalities were correlated with ART and BDAE severity scales. The relationships between aphasia severity, FA values, and infarct volumes were investigated using global and partial correlations. Results. We found a critical area associated with aphasia severity overlapping with the arcuate and the inferior fronto-occipital fasciculi, resulting in a combined disconnection of the dorsal and ventral pathways. ART scores were inversely correlated with FA values in this region, with greater severity present with lower FA values (correlation coefficient = −0.833, P < .0001). The proportion of variance explained by the FA value was higher than the proportion of variance explained by the infarct volume (R2 = 68% vs 27%, P = .01). The impact of infarct volume on aphasia severity disappeared when damage to this critical white matter area was taken into account (P = .38). Conclusion. The assessment of the integrity of this region may potentially have a clinical impact in neurorehabilitation and acute decision making.

P368: Association between dysphagia and OSAS in acute stroke patients

P368: Association between dysphagia and OSAS in acute stroke patients

Characteristics of Cognitive Impairment in Patients With Post-stroke Aphasia

ObjectiveTo analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity.MethodsThirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity.ResultsRight hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests.ConclusionCognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.

Excitatory Deep Transcranial Magnetic Stimulation With H-Coil Over the Right Homologous Broca’s Region Improves Naming in Chronic Post-stroke Aphasia

Background. The role of the right hemisphere in poststroke aphasia recovery is still controversial and the effects of repetitive transcranial magnetic stimulation (rTMS) over the right homologous Broca’s region have been seldom investigated. Objective. This study aimed to compare the effect of excitatory, inhibitory, and sham rTMS delivered with H-coil over the right inferior frontal gyrus in chronic aphasic patients. Methods. Five right-handed poststroke aphasic patients underwent a picture naming task before and immediately after each of 3 sessions of rTMS: excitatory (10 Hz), inhibitory (1 Hz), and sham rTMS, in random sequence and separated by at least 1 week. Results. Only the excitatory 10-Hz stimulation was associated with a significant improvement in naming performance (P = .043) and was significantly more effective than 1-Hz rTMS (P = .043). Conclusions. A single session of excitatory deep brain rTMS over the right inferior frontal gyrus with H-coil significantly improves naming in right-handed chronic poststroke aphasic patients. This result is in line with the hypothesis of a positive, rather than detrimental, role of the right hemisphere in chronic aphasia due to a left-hemispheric stroke.

146. Excitatory deep transcranial magnetic stimulation with H-coil over the right homologous Broca’s region improves naming in chronic post-stroke aphasia

The role of the right hemisphere in post-stroke aphasia recovery is still controversial and the effects of repetitive transcranial magnetic stimulation over the right homologous Broca’s region have been seldom investigated. This study aimed to compare the effect of excitatory, inhibitory and sham rTMS delivered with H-coil over the right inferior frontal gyrus (IFG) in chronic aphasic patients. Five right-handed post-stroke aphasic patients underwent a picture naming task before and immediately after each of three sessions of rTMS: excitatory (10 Hz), inhibitory (1 Hz) and sham rTMS, in random sequence and separated by at least 1 week. Only the excitatory 10 Hz stimulation was associated with a significant improvement in naming performance, ( p = 0.043) and was significantly more effective than 1 Hz rTMS ( p = 0.043). A single session of excitatory deep brain rTMS over the right IFG with H-coil significantly improves naming in right-handed chronic post-stroke aphasic patients. This result is in line with the hypothesis of a positive, rather than detrimental role, of the right hemisphere in chronic aphasia due to a left-hemispheric stroke.

Connectivity between Right Inferior Frontal Gyrus and Supplementary Motor Area Predicts After-Effects of Right Frontal Cathodal tDCS on Picture Naming Speed

BackgroundCathodal transcranial direct current stimulation (tDCS) of the right frontal cortex improves language abilities in post-stroke aphasic patients. Yet little is known about the effects of right frontal cathodal tDCS on normal language function. Objective/hypothesisTo explore the cathodal tDCS effects of the right-hemispheric homologue of Broca's area on picture naming in healthy individuals. We hypothesized that cathodal tDCS improves picture naming and that this effect is determined by the anatomical and functional connectivity of the targeted region. MethodsCathodal and sham tDCS were applied to the right inferior frontal gyrus in 24 healthy subjects before a picture-naming task. All participants were studied with magnetic resonance imaging at pre-interventional baseline. Probabilistic tractography and dynamic causal modeling of functional brain activity during a word repetition task were applied to characterize anatomical and functional connectivity. ResultsSubjects named pictures faster after cathodal relative to sham tDCS. The accelerating effect of tDCS was explained by a reduced frequency of very slow responses. tDCS-induced acceleration of picture naming correlated with larger volumes of the tract connecting the right Broca's area and the supplementary motor area (SMA) and greater functional coupling from the right SMA to the right Broca's area. ConclusionsThe results support the notion that the after-effects of tDCS on brain function are at least in part determined by the anatomical and functional connectivity of the targeted region.

Investigação da queixa de disfagia em pacientes afásicos

OBJETIVOS: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia. MÉTODO: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram. RESULTADOS: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição. CONCLUSÕES: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.

Transcranial Magnetic Stimulation Combined with Speech and Language Training in Early Aphasia Rehabilitation: A Randomized Double-Blind Controlled Pilot Study

Background: Functional neuroimaging studies with poststroke aphasia patients have shown increased activation of the unaffected hemisphere, which hypothetically reflects a maladaptive strategy of brain reorganization. Objective: We investigated whether repetitive transcranial magnetic stimulation (rTMS) inhibiting the right-hemisphere homologue of Broca’s area improves language restitution if combined with speech/language therapy. Methods: Forty aphasic patients during the subacute phase of ischemic stroke were randomized to a 3-week aphasia rehabilitation protocol in combination with real or sham rTMS. Naming, repetition, and comprehension were assessed using the Boston Diagnostic Aphasia Examination at baseline, immediately after therapy, and 15 weeks after completing treatment. Results: Although language functions improved in both experimental and control groups after 3 weeks, only slight group differences in degree of recovery were revealed between patients receiving rTMS and control participants. Follow-up revealed that severely aphasic rTMS patients demonstrated significantly greater improvement than patients receiving sham stimulation in repetition. Conclusions: Inhibitory rTMS applied to the right frontal language homologue is not effective for all poststroke aphasia patients, although it might benefit selected patients.

No effects of anodal transcranial direct stimulation on language abilities in early rehabilitation of post-stroke aphasic patients

Background and purposeRecent research suggests that an increased level of stroke-affected left hemisphere cortical (especially frontal) excitability is associated with better language improvement in aphasic patients. Anodal transcranial direct current stimulation (A-tDCS), increasing cortical activity, may facilitate perilesional left hemisphere recruitment to subserve language processing and enhance effects of behavioural therapy. The aim of the study (randomized, double-blind, sham-controlled) was to evaluate the effectiveness of repeated A-tDCS over Broca area as a strategy to enhance aphasia recovery during early post-stroke rehabilitation. Material and methodsThirty-seven participants with moderate or severe aphasia were randomized to receive 15 consecutive daily sessions of A-tDCS (1 mA, 10 min; experimental group, n = 18) or sham stimulation (1 mA, 25 s; control group, n = 19) followed by language therapy. Effects of tDCS were assessed using the Boston Diagnostic Aphasia Examination, performed before and after the rehabilitation, and three months later. ResultsThe results did not confirm a positive impact of repeated A-tDCS, preceding language therapy, on language abilities in our patients. Although both groups improved after the therapy, there were no statistically significant differences between groups in either short-term or long-term tDCS effects. Effect sizes for the experimental group, at post-treatment and the 3-month follow-up, were slightly higher than in controls but insufficient to infer any beneficial influence of the applied intervention. ConclusionsThe findings do not support A-tDCS functional benefits during early rehabilitation of post-stroke aphasia. Further research is needed to explore the effectiveness of this kind of neuromodulation.

The Therapeutic Effect of Neurologic Music Therapy and Speech Language Therapy in Post-Stroke Aphasic Patients

ObjectiveTo investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients.MethodsTwenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy.ResultsSignificant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients.ConclusionWe concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.

Can Combination Therapy of Conventional and Oriental Medicine Improve Poststroke Aphasia? Comparative, Observational, Pragmatic Study

The aim of the present study was to determine the effectiveness of oriental medicine therapy on poststroke aphasia. The outcome was measured as the delta value of the Aphasic Quotient score. Patients completed test at two timepoints: baseline and discharge time. Patients who received conventional therapy and language therapy were grouped in the Only Language Therapy group. Patients who received conventional therapy, language therapy, and an Oriental medicine regimen were grouped in the Combined oriental Medicine Therapy group. We compared the delta value of the Aphasic Quotient score between two groups. The Combined Oriental Medicine group exhibited a greater improvement than the Only Language Therapy group in the total Aphasic Quotient score and most subsection scores. In particular, there were statistically significant differences in total Aphasic Quotient score and subsections such as spontaneous speech, content delivery, comprehension, auditory verbal comprehension, and command performance. Among severe aphasic patients, the improvement of the Combined oriental Medicine group was better than that of the Only Language Therapy group. Through this study, we suggest combination therapy with the administration of oriental medicine and language therapy can be helpful in the treatment of post-stroke aphasic patients.

Effect of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Naming Abilities in Early-Stroke Aphasic Patients: A Prospective, Randomized, Double-Blind Sham-Controlled Study

Background and Purpose. Functional brain imaging studies with aphasia patients have shown increased cortical activation in the right hemisphere language homologues, which hypothetically may represent a maladaptive strategy that interferes with aphasia recovery. The aim of this study was to investigate whether low-frequency repetitive transcranial magnetic stimulation (rTMS) over the Broca's homologues in combination with speech/language therapy improves naming in early-stroke aphasia patients. Methods. 26 right-handed aphasic patients in the early stage (up to 12 weeks) of a first-ever left hemisphere ischemic stroke were randomized to receive speech and language therapy combined with real or sham rTMS. Prior to each 45-minute therapeutic session (15 sessions, 5 days a week), 30 minutes of 1-Hz rTMS was applied. Outcome measures were obtained at baseline, immediately after 3 weeks of experimental treatment and 15 weeks; posttreatment using the Computerized Picture Naming Test. Results. Although both groups significantly improved their naming abilities after treatment, no significant differences were noted between the rTMS and sham stimulation groups. The additional analyses have revealed that the rTMS subgroup with a lesion including the anterior part of language area showed greater improvement primarily in naming reaction time 15 weeks after completion of the therapeutic treatment. Improvement was also demonstrated in functional communication abilities. Conclusions. Inhibitory rTMS of the unaffected right inferior frontal gyrus area in combination with speech and language therapy cannot be assumed as an effective method for all poststroke aphasia patients. The treatment seems to be beneficial for patients with frontal language area damage, mostly in the distant time after finishing rTMS procedure.

Cathodal transcranial direct current stimulation of the right Wernicke’s area improves comprehension in subacute stroke patients

Previous studies have shown the appearance of right-sided language-related brain activity in right-handed patients after a stroke. Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have been shown to modulate excitability in the brain. Moreover, rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients. Here, we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke. We hypothesized that tDCS applied to the left superior temporal gyrus (Wernicke’s area) or the right Wernicke’s area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke. Participants included right-handed subacute stroke patients with global aphasia due to ischemic infarct of the left M1 or M2 middle cerebral artery. Patients were randomly divided into three groups: patients who received anodal tDCS applied to the left superior temporal gyrus, patients who received cathodal tDCS applied to the right superior temporal gyrus, and patients who received sham tDCS. All patients received conventional speech and language therapy during each period of tDCS application. The Korean-Western Aphasia Battery (K-WAB) was used to assess all patients before and after tDCS sessions. After intervention, all patients had significant improvements in aphasia quotients, spontaneous speech, and auditory verbal comprehension. However, auditory verbal comprehension improved significantly more in patients treated with a cathode, as compared to patients in the other groups. These results are consistent with the role of Wernicke’s area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke, suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke.

Short-Term Anomia Training and Electrical Brain Stimulation

Language training success in chronic aphasia remains only moderate. Electric brain stimulation may be a viable way to enhance treatment efficacy. In a randomized, double-blind, sham-controlled crossover trial, we assessed if anodal transcranial direct current stimulation compared to cathodal transcranial direct current stimulation and sham stimulation over the right temporo-parietal cortex would improve the success of short-term high-frequency anomia training. Twelve chronic poststroke aphasia patients were studied. Naming outcome was assessed after training and 2 weeks later. All training conditions led to a significant increase in naming ability, which was retained for at least 2 weeks after the end of the training. Application of anodal transcranial direct current stimulation significantly enhanced the overall training effect compared to sham stimulation. Baseline naming ability significantly predicted anodal transcranial direct current stimulation effects. Anodal transcranial direct current stimulation applied over the nonlanguage dominant hemisphere can enhance language training outcome in chronic aphasia. Clinical Trial Registration- URL: www.clinicaltrials.gov/. Unique identifier: NCT00822068.