Post-stroke Aphasia Research Articles

Efficacy and safety of mirror therapy for post-stroke aphasia: A systematic review and meta-analysis protocol.

Aphasia is one of the most common complications of stroke. Mirror therapy (MT) is promising rehabilitation measure for the treatment of post-stroke aphasia. Although some studies suggested that MT is effective and safe for aphasia, the effects and safety remain uncertain due to lacking strong evidence, such as the relevant systematic review and meta- analysis. This study will search PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network (CNKI), WANFANG, China Biomedical Literature Database (CBM), from inception to 1th May 2023 to identify any eligible study. No language or date of publication shall be limited. We will only include randomised controlled trials of MT in the Treatment of poststroke aphasia. Two investigators will work separately on the study selection, data extraction, and study quality assessment. The western aphasia battery (WAB) and aphasia quotient (AQ) will be included as the main outcomes. Boston diagnostic aphasia examination method (BDAE), Chinese standard aphasia examination (CRRCAE) will be included as the secondary outcomes. The statistical analysis will be conducted by RevMan V.5.4 software. The risk of bias of included studies will be assessed by the Cochrane 'Risk of bias' tool. The quality of proof of the results will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation guidelines. The finding will be presented in a journal or related conferences. This study will provide a basis for whether mirror therapy (MT) is effective and safe in the treatment of post-stroke aphasia. Systematic review registration INPLASY registration number: INPLASY 202340054.

Akupunktur vs. Sham-Akupunktur als komplementäre Therapieoption bei Patienten mit motorischer Aphasie nach Schlaganfall

Akupunktur vs. Sham-Akupunktur als komplementäre Therapieoption bei Patienten mit motorischer Aphasie nach Schlaganfall

Under pressure: the interplay of hypertension and white matter hyperintensities with cognition in chronic stroke aphasia.

While converging research suggests that increased white matter hyperintensity load is associated with poorer cognition, and the presence of hypertension is associated with increased white matter hyperintensity load, the relationship among hypertension, cognition and white matter hyperintensities is not well understood. We sought to determine the effect of white matter hyperintensity burden on the relationship between hypertension and cognition in individuals with post-stroke aphasia, with the hypothesis that white matter hyperintensity load moderates the relationship between history of hypertension and cognitive function. Health history, Fazekas scores for white matter hyperintensities and Wechsler Adult Intelligence Scale Matrix Reasoning subtest scores for 79 people with aphasia collected as part of the Predicting Outcomes of Language Rehabilitation study at the Center for the Study of Aphasia Recovery at the University of South Carolina and the Medical University of South Carolina were analysed retrospectively. We found that participants with a history of hypertension had increased deep white matter hyperintensity severity (P < 0.001), but not periventricular white matter hyperintensity severity (P = 0.116). Moderation analysis revealed that deep white matter hyperintensity load moderates the relationship between high blood pressure and Wechsler Adult Intelligence Scale scores when controlling for age, education, aphasia severity and lesion volume. The interaction is significant, showing that a history of high blood pressure and severe deep white matter hyperintensities together are associated with poorer Matrix Reasoning scores. The overall model explains 41.85% of the overall variation in Matrix Reasoning score in this group of participants. These findings underscore the importance of considering cardiovascular risk factors in aphasia treatment, specifically hypertension and its relationship to brain health in post-stroke cognitive function.

A study on the reliability and validity of the Japanese version of the Scenario Test for people with chronic stroke-induced aphasia: A cross-sectional study.

The Scenario Test is recognised for its effectiveness in assessing the interactive aspects of functional communication in people with post-stroke aphasia (PWA). To develop a Japanese version of the Scenario Test (Scenario Test-JP) and assess its reliability and validity. Among 66 participants, we selected 61 individuals: 34 PWA and 27 healthy controls (HCs). We modified the Scenario Test-JP based on the UK version and subsequently evaluated its reliability (internal consistency, test-retest and intra-rater and inter-rater reliabilities) and validity (convergent and discriminant) by comparing PWA and HCs. The Scenario Test-JP showed strong reliability with a Cronbach's α of 0.93, test-retest reliability with an intraclass correlation coefficient (ICC) of 0.97, intra-rater reliability with an ICC of 0.95-1.00, and inter-rater reliability with an ICC of 0.96. The validity of the test was confirmed with concurrent scores ranging from ρ = 0.37 to 0.76 (p < 0.05) and known-groups validity (p < 0.001, r = -0.56). The reliability and validity of the Scenario Test-JP align with those of the original Dutch version and the UK and Greek versions. Additionally, the assessment can now include extended alternative communication methods, such as digital devices, indicating the potential of the Scenario Test-JP for modern Japanese speech-language therapy. What is already known on the subject Interactive communication is a facet of functional communication and is crucial for evaluating engagement and participation of people with aphasia (PWA) in speech-language therapy. The Scenario Test provides valuable information for planning speech-language treatment strategies by assessing dialogic communication. What this study adds This study describes the development of the Scenario Test-JP for use with Japanese speakers and Japanese PWA, which is adapted from the Scenario Test UK version. This study evaluated the reliability and validity of this assessment tool and provided supporting evidence. What are the clinical implications of this work? The reliability and validity of the Scenario Test-JP were consistent with those of the Dutch, UK and Greek versions. The Scenario Test-JP contributes to speech-language therapy in Japan, where high-quality support for the activities and participation of PWA is required. Insights from the Scenario Test The Scenario Test plays a crucial role in evaluating the functional communication skills of people with post-stroke aphasia (PWA). Enhancing functional communication has been linked to improved social engagement among PWA, which in turn influences their overall quality of life (QOL). Issues addressed by the Scenario Test The Scenario Test aids in delineating rehabilitation objectives for activities and participation among PWA, particularly concerning functional communication. The test facilitates tailored support for PWAs' interactive communication and forms the foundation for appropriate speech-language therapy interventions. Transformation of speech-language therapy (SLT) in Japan through the introduction of the Scenario Test-JP The integration of the Scenario Test-JP could enhance the SLT services provided to PWA in Japan. With Japan experiencing an unprecedented ageing population, the prevalence of social isolation and diminished QOL resulting from communication disorders like stroke-induced aphasia is expected to rise. Consequently, the SLT rehabilitation sector in Japan is actively seeking effective interventions to support functional communication among PWA. Hence, the adoption of the Scenario Test-JP is anticipated to streamline the evaluation of functional communication, facilitating the judicious selection and timely provision of assistance to PWA in SLT, including guidance on communication partner support and communication skill training.

Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project

ObjectivePeople with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that...

Personalised functional imaging-guided multitarget continuous theta burst stimulation for post-stroke aphasia: study protocol for a randomised controlled trial

IntroductionContinuous theta burst stimulation (cTBS), a form of repetitive transcranial magnetic stimulation (rTMS), targeting the language network in the right hemisphere of post-stroke aphasia (PSA) patients shows promising results in...

Structural Neuroplasticity Effects of Singing in Chronic Aphasia.

Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.

Prolonged intermittent theta burst stimulation for post-stroke aphasia: protocol of a randomized, double-blinded, sham-controlled trial.

Post-stroke aphasia (PSA) is one of the most devastating symptoms after stroke, yet limited treatment options are available. Prolonged intermittent theta burst stimulation (piTBS) is a promising therapy for PSA. However, its efficacy remains unclear. Therefore, we aim to investigate the efficacy of piTBS over the left supplementary motor area (SMA) in improving language function for PSA patients and further explore the mechanism of language recovery. This is a randomized, double-blinded, sham-controlled trial. A total of 30 PSA patients will be randomly allocated to receive either piTBS stimulation or sham stimulation for 15 sessions over a period of 3 weeks. The primary outcome is the Western Aphasia Battery Revised (WAB-R) changes after treatment. The secondary outcomes include The Stroke and Aphasia Quality of Life Scale (SAQOL-39 g), resting-state electroencephalogram (resting-state EEG), Event-related potentials (ERP), brain derived neurotrophic factor (BDNF). These outcome measures are assessed before treatment, after treatment, and at 4-weeks follow up. This study was registered in Chinese Clinical Trial Registry (No. ChiCTR23000203238). This study protocol is promising for improving language in PSA patients. Resting-state EEG, ERP, and blood examination can be used to explore the neural mechanisms of PSA treatment with piTBS. https://www.chictr.org.cn/index.html, ChiCTR2300074533.

Remapping and Reconnecting the Language Network after Stroke.

Here, we review the literature on neurotypical individuals and individuals with post-stroke aphasia showing that right-hemisphere regions homologous to language network and other regions, like the right cerebellum, are activated in language tasks and support language even in healthy people. We propose that language recovery in post-stroke aphasia occurs largely by potentiating the right hemisphere network homologous to the language network and other networks that previously supported language to a lesser degree and by modulating connection strength between nodes of the right-hemisphere language network and undamaged nodes of the left-hemisphere language network. Based on this premise (supported by evidence we review), we propose that interventions should be aimed at potentiating the right-hemisphere language network through Hebbian learning or by augmenting connections between network nodes through neuroplasticity, such as non-invasive brain stimulation and perhaps modulation of neurotransmitters involved in neuroplasticity. We review aphasia treatment studies that have taken this approach. We conclude that further aphasia rehabilitation with this aim is justified.

Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features.

Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies. We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results. Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence. Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency. https://doi.org/10.23641/asha.25537237.

Language assessment in persons with aphasia early after thrombolysis: the utility of multilevel procedures of discourse analysis

ABSTRACT Background Clinical guidelines recommend the administration of intravenous recombinant tissue plasminogen activator thrombolytic treatment to persons who suffered ischemic stroke within 4,5 hours since onset. However, the available evidence on the potential improvement of language after thrombolysis is still scanty. Aims This study assessed the effect of thrombolytic treatment in language recovery in persons with stroke aphasia (PWA) comparing the efficacy of traditional language assessments and a multilevel procedure of discourse analysis applied to the Cookie Theft picture descriptions taken from the National Institute of Health Stroke Scale (NIHSS). Methods and procedures Fortyeight individuals participated in the study: sixteen PWA who received thrombolysis; sixteen PWA who did not receive it; sixteen healthy controls. The two groups of PWA were balanced in terms of age, education, gender, lateralization of the lesion, and stroke severity. They were administered the NIHSS and a bedside language assessment battery when entering the neurological clinic (T0) and after approximately 72 hours (T1). Their narrative discourse descriptions were analyzed with a multilevel procedure for discourse analysis. Outcomes and results The two groups of PWA had similar linguistic difficulties at T0 as reflected by comparable Composite Verbal Scores and performance on traditional linguistic bedside assessment (Aphasia PostStroke Acute Assessment test; Furlanis et al., 2018). Discourse analysis highlighted the presence of more omissions of function words and errors of cohesion in the PWA who would receive thrombolysis with respect to healthy controls and allowed for the identification, in both groups, of difficulties that could not be detected through a traditional assessment. At T1 the analyses showed the presence of improvements likely reflecting a generalized spontaneous recovery in both groups of PWA and a more specific recovery triggered by thrombolysis concerning the production of global coherence errors in treated patients only. An inspection of the gravity of the linguistic symptoms at the individual level revealed high interindividual variability in this early phase suggesting that thrombolysis reduced the severity of the impairment also in the production of informative words. Conclusions Thrombolysis reduces the gravity of some linguistic symptoms within a few hours after treatment. Multilevel procedures of discourse analysis can identify these subtle improvements.

Investigating silent pauses in connected speech: integrating linguistic, neuropsychological, and neuroanatomical perspectives across narrative tasks in post-stroke aphasia.

Silent pauses are regarded as integral components of the temporal organization of speech. However, it has also been hypothesized that they serve as markers for internal cognitive processes, including word access, monitoring, planning, and memory functions. Although existing evidence across various pathological populations underscores the importance of investigating silent pauses' characteristics, particularly in terms of frequency and duration, there is a scarcity of data within the domain of post-stroke aphasia. The primary objective of the present study is to scrutinize the frequency and duration of silent pauses in two distinct narrative tasks within a cohort of 32 patients with chronic post-stroke aphasia, in comparison with a control group of healthy speakers. Subsequently, we investigate potential correlation patterns between silent pause measures, i.e., frequency and duration, across the two narrative tasks within the patient group, their performance in neuropsychological assessments, and lesion data. Our findings showed that patients exhibited a higher frequency of longer-duration pauses in both narrative tasks compared to healthy speakers. Furthermore, within-group comparisons revealed that patients tended to pause more frequently and for longer durations in the picture description task, while healthy participants exhibited the opposite trend. With regard to our second research question, a marginally significant interaction emerged between performance in semantic verbal fluency and the narrative task, in relation to the location of silent pauses-whether between or within clauses-predicting the duration of silent pauses in the patient group. However, no significant results were observed for the frequency of silent pauses. Lastly, our study identified that the duration of silent pauses could be predicted by distinct Regions of Interest (ROIs) in spared tissue within the left hemisphere, as a function of the narrative task. Overall, this study follows an integrative approach of linguistic, neuropsychological and neuroanatomical data to define silent pauses in connected speech, and illustrates interrelations between cognitive components, temporal aspects of speech, and anatomical indices, while it further highlights the importance of studying connected speech indices using different narrative tasks.

The role of language-related functional brain regions and white matter tracts in network plasticity of post-stroke aphasia.

The neural mechanisms underlying language recovery after a stroke remain controversial. This review aimed to summarize the plasticity and reorganization mechanisms of the language network through neuroimaging studies. Initially, we discussed the involvement of right language homologues, perilesional tissue, and domain-general networks. Subsequently, we summarized the white matter functional mapping and remodeling mechanisms associated with language subskills. Finally, we explored how non-invasive brain stimulation (NIBS) promoted language recovery by inducing neural network plasticity. It was observed that the recruitment of right hemisphere language area homologues played a pivotal role in the early stages of frontal post-stroke aphasia (PSA), particularly in patients with larger lesions. Perilesional plasticity correlated with improved speech performance and prognosis. The domain-general networks could respond to increased "effort" in a task-dependent manner from the top-down when the downstream language network was impaired. Fluency, repetition, comprehension, naming, and reading skills exhibited overlapping and unique dual-pathway functional mapping models. In the acute phase, the structural remodeling of white matter tracts became challenging, with recovery predominantly dependent on cortical activation. Similar to the pattern of cortical activation, during the subacute and chronic phases, improvements in language functions depended, respectively, on the remodeling of right white matter tracts and the restoration of left-lateralized language structural network patterns. Moreover, the midline superior frontal gyrus/dorsal anterior cingulate cortex emerged as a promising target for NIBS. These findings offered theoretical insights for the early personalized treatment of aphasia after stroke.

Role of tPA in Aphasia Recovery: A Meta-Analysis of Recent Studies

ABSTRACT Background Tissue plasminogen activator (tPA) is a common therapeutic agent approved to treat patients with stroke. When the agent is administered within 4.5 hours of stroke onset, tPA administration helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment. However, research evaluating the use of tPA on aphasia – loss of the ability to understand or express speech – a common post-stroke condition is limited. A meta-analysis of available evidence was performed to assess the association between the use of tPA on aphasia post-stroke. Methods A literature search was performed using the PubMed, Web of Science, and SCOPUS electronic database using keywords “tPA”, “tissue plasminogen activator”, “aphasia”, and “stroke” published in English since 2010. An initial search revealed 7, 069, 6,682, and 289 studies in PubMed, Web of Science, and SCOPUS, respectively. Studies without a measure of aphasia impairment in adults as well as case studies and reviews were excluded. After quality assessment and a review of study abstracts, 14 relevant studies were identified for full text review. Among the 14, ten were deemed appropriate for inclusion and feature extraction. Results Associations between tPA and aphasia outcomes in each of the included studies were translated to odds ratios (ORs) and study features were coded for inclusion in a random effects meta regression. Results revealed a statistically significantly higher likelihood of improvement in the level of post-stroke aphasia among those receiving tPA compared with those not receiving tPA (odds ratio [OR], 2.1963, CI = 0.5994, 3.7932). Model statistics did however indicate substantial heterogeneity (I2 = 96.94%, Ƭ2 = 32.65) between studies. After removal of two outliers from the analysis set, the estimates improved substantially (OR = 1.8643, CI = 1.2131, 2.5155), and heterogeneity was reduced (I2 = 76.28%, Ƭ2 = 4.22). Estimates were robust to the inclusion of study location, metric used to measure aphasia, observed recovery duration, and size of the sample. Conclusion This meta-analysis found an increased likelihood of aphasia recovery in patients receiving tPA following stroke and significant improvement in communication from tPA receipt. However, further prospective studies with greater sample heterogeneity are needed to determine the appropriate window for tPA use, the duration of improvement, and the long-term effects on communication outcomes.

Feasibility of a Guided Meditation Program as an Adjunct Therapy in the Treatment of Post-stroke Aphasia (P7-11.010)

Feasibility of a Guided Meditation Program as an Adjunct Therapy in the Treatment of Post-stroke Aphasia (P7-11.010)

Clinico-radiological factors associated with aphasia outcome in post stroke patients: A prospective follow up study from eastern part of India

BackgroundAphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and factors affecting its recovery. MethodsWe conducted a prospective study of patients with first left Middle or Anterior Cerebral Artery infarct or Intracerebral Hemorrhage (ICH) with aphasia admitted within 14 days of stroke onset. Aphasia Quotient (AQ) was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. Magnetic Resonance Imaging of brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained. Results36 patients [8 ICH and 28 Acute Ischemic Stroke (AIS)] were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its subscores) were significantly higher in ICH than AIS. National Institutes of Health Stroke Scale score at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. Laterality Index of Fractional Anisotropy of Arcuate Fasciculus [LI-FA (AF)] had significant positive correlation with AQ2 and naming score at 3 months. Laterality Index of Mean Diffusivity of Arcuate Fasciculus [LI-MD (AF)] had significant negative correlation with AQ1, AQ2 and all subcomponents of AQ2. Significant positive correlation was seen between improvements in Modified Rankin Scale score and AQ. ConclusionThe study shows that DTI can be used to predict severity of aphasia at follow up and recovery in language and motor functions occur in parallel

Aphasia Depression and Psychological Therapy (ADaPT): Perspectives of People with Post-Stroke Aphasia on Participating in a Modified Cognitive Behavioral Therapy.

Aphasia, a communication disability commonly caused by stroke, can profoundly affect a person's mood and identity. We explored the experiences of stroke survivors with aphasia and depression who received a modified cognitive behavioral therapy (CBT)-based psychological intervention. The therapy is manualized with a flexible treatment protocol, including 10 individually based therapy sessions (+2 booster sessions) either via telehealth or in person. Six participants with chronic aphasia (60% of the total sample) participated in in-depth interviews that were analyzed using reflexive thematic analysis. Two core themes were derived from the data: the first theme, helpful elements of therapy-doing enjoyable activities, new ways of thinking, problem solving, working with the experienced therapist, and using telehealth; and the second theme, making progress-mood, communication, acceptance of the 'new me', and improving relationships. All participants found the therapy to be helpful in managing mood problems with various elements being beneficial depending on the individual, highlighting the importance of tailoring the intervention. Therefore, delivering modified CBT to individuals with aphasia is likely to be acceptable both in person and through telehealth. Further evaluation of the intervention and its impact on mood would be beneficial.

Profiling word retrieval abilities in persons with aphasia - A preliminary study

Various methods are used to elicit the naming responses. The current study aimed to assess different naming abilities in persons with aphasia. Naming abilities were assessed using varied types of naming tasks for PWA. PWA was subjected to eight types of naming tasks [Confrontation Naming (CN), Phonemic Fluency (PF), Semantic Fluency (SF), Serial Naming (SN), Ordinate Naming (ON), Automated Naming (AN), Responsive Naming (RN) and Sentence Completion (SC)] and compared with age, education matched neurotypical individuals (n=15). The assessment was carried out in the Kannada Language. The raw scores obtained for each task were tabulated and subjected to statistical analysis. On eight naming tasks, neurotypical individuals performed better than persons with post-stroke aphasia. Mann Whitney U test revealed a significant difference in the phonemic fluency task in both groups of participants with a value less than 0.05. Friedman analysis with adjusted Bonferroni showed a significant difference in pairwise comparison for eight naming tasks. Among which pairs with phonemic fluency task had a significant difference in both the groups (p&lt; 0.05). The correlation between language impairment in PWA and types of naming was studied using WAB AQ scores with accuracy scores on different types of naming tasks. A significant correlation was seen between WAB AQ and the Phonemic fluency task. The nature of the task and the factors affecting the naming of each task influence the performance of the individuals. PWA has a difference in brain mechanism for naming compared to NTI. Phonemic fluency is recommended for regular naming assessments as it is simple, easy, and quick to administer. Also, it taps both the cognitive and linguistic abilities of an individual. Language impairment and different types of naming are well related in the current study. The need to assess all types of naming to understand the word production deficit is justified.

Cerebellar tDCS enhances functional communication skills in chronic Aphasia

ABSTRACT Background Transcranial direct current stimulation (tDCS) has emerged as a possible neuromodulatory tool to augment language therapy in post-stroke aphasia. However, there is limited information on whether tDCS may help to improve everyday functional communication. Aims To investigate whether cerebellar tDCS combined with computerized aphasia treatment improves functional communication skills in individuals with chronic aphasia. Methods and Procedures In a randomized, double-blind, sham-controlled, within-subject crossover study, participants received 15 sessions of anodal (n = 14) or cathodal (n = 14) cerebellar tDCS plus computerized aphasia treatment then sham plus computerized aphasia treatment, or the opposite order. Linear mixed-effects regression models were performed to evaluate (1) the effect of tDCS treatment on change in functional communication skills on the two dimensions of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA-FACS): Communication Independence (CI) scale and Qualitative Dimension of Communication (QDC) scale, and (2) the relationship between functional communication skills and trained and untrained naming abilities. Outcomes and Results The results showed significant tDCS-induced gains for the overall QDC mean score, but not for the overall CI mean score. Cerebellar stimulation was more effective than sham for the overall QDC mean score immediately post-treatment, 2-weeks post-treatment and 2-months post-treatment. Follow up analysis separated by group showed that the change in the overall QDC mean score (combining both phases) were similar in participants receiving anodal or cathodal stimulation. We also found a significant linear association between the ASHA-FACS overall CI mean change scores and trained and untrained naming change scores for the tDCS condition but not sham. Conclusions Our study provides preliminary evidence that cerebellar tDCS coupled with computerized aphasia treatment has the potential to improve the overall qualitative dimensions of functional communication skills in individuals with chronic aphasia. Clinical Trial Registration Cerebellar Transcranial Direct Current Stimulation and Aphasia Treatment [NCT02901574]

Meta-analysis and systematic review of the relationship between sex and the risk or incidence of poststroke aphasia and its types

ObjectiveTo analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice.Data sourcesEmbase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023.Study selectionIncluding the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex.Data extractionStudies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded.Data synthesis36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19–1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05).ConclusionsThere are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.