Post-stroke Aphasia Rehabilitation Research Articles

'A Meaningful Difference, but Not Ultimately the Difference I Would Want': A Mixed-Methods Approach to Explore and Benchmark Clinically Meaningful Changes in Aphasia Recovery.

Outcome measurement instruments (OMIs) are used to gauge the effects of treatment. In post-stroke aphasia rehabilitation, benchmarks for meaningful change are needed to support the interpretation of patient outcomes. This study is part of a research programme to establish minimal important change (MIC) values (the smallest change above which patients perceive themselves as importantly changed) for core OMIs. As a first step in this process, the views of people with aphasia and clinicians were explored, and consensus was sought on a threshold for clinically meaningful change. Sequential mixed-methods design was employed. Participants included people with post-stroke aphasia and speech pathologists. People with aphasia were purposively sampled based on time post-stroke, age and gender, whereas speech pathologists were sampled according to their work setting (hospital or community). Each participant attended a focus group followed by a consensus workshop with a survey component. Within the focus groups, experiences and methods for measuring meaningful change during aphasia recovery were explored. Qualitative data were transcribed and analysed using reflexive thematic analysis. In the consensus workshop, participants voted on thresholds for meaningful change in core outcome constructs of language, communication, emotional well-being and quality of life, using a six-point rating scale (much worse, slightly worse, no change, slightly improved, much improved and completely recovered). Consensus was defined a priori as 70% agreement. Voting results were reported using descriptive statistics. Five people with aphasia (n = 4, > 6 months after stroke; n = 5, < 65 years; n = 3, males) and eight speech pathologists (n = 4, hospital setting; n = 4, community setting) participated in one of four focus groups (duration: 92-112 min). Four themes were identified describing meaningful change as follows: (1) different for every single person; (2) small continuous improvements; (3) measured by progress towards personally relevant goals; and (4) influenced by personal factors. 'Slightly improved' was agreed as the threshold of MIC on the anchor-rating scale (75%-92%) within 6 months of stroke, whereas after 6 months there was a trend towards supporting 'much improved' (36%-66%). Our mixed-methods research with people with aphasia and speech pathologists provides novel evidence to inform the definition of MIC in aphasia rehabilitation. Future research will aim to establish MIC values for core OMIs. This work is the result of engagement between people with lived experience of post-stroke aphasia, including people with aphasia, family members, clinicians and researchers. Engagement across the research cycle was sought to ensure that the research tasks were acceptable and easily understood by participants and that the outcomes of the study were relevant to the aphasia community. This engagement included the co-development of a plain English summary of the results. Advisors were remunerated in accordance with Health Consumers Queensland guidelines. Interview guides for clinicians were piloted by speech pathologists working in aphasia rehabilitation.

The “I” in ICAPs: examining treatment intensity under the microscope

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) provide high doses of treatment over short periods. Treatment intensity in post-stroke aphasia rehabilitation and research is not well understood and is typically underspecified, including within ICAPs and modified Intensive Comprehensive Aphasia Programs (mICAPs), in which intensity is a fundamental design component. One recently developed model of treatment conceptualisation, the Multidimensional Dose Articulation Framework (MDAF), may offer a systematic, comprehensive, and granular method of characterising treatment intensity, though this framework has not yet been used to capture elements of intensity and dose during an ICAP or mICAP. Aims The purpose of this paper is to examine and describe increasingly specific details of treatment intensity for both an ICAP and mICAP delivered at the University of Montana (UMT). Methods & Procedures Fourteen participants with aphasia attended an 84-hour ICAP (n = 8) or a 24-hour mICAP (n = 6) delivered by graduate student clinicians at UMT. Ethics approval was obtained from the UMT IRB (#13-23). We examined intensity and dose using components of the MDAF including broad temporal parameters, and episode-specific length and intensity. Descriptive statistics were used to report group-level, participant-level, and treatment-level parameters. Outcomes & Results In this descriptive manuscript, we use a series of vignettes to report temporal parameters from the MDAF including treatment duration, days, sessions, and session density, and episode-level characteristics including episode length and episode intensity. Vignette one examines ICAP and mICAP planned versus actual temporal parameters. Vignette two describes episode-level detail across two evidence-based treatments administered during the ICAP. Vignette three details differences in delivery of a single treatment approach between two participants. In each vignette, we discuss the benefits and challenges of tracking treatment intensity with fine detail. Conclusions Comprehensive specification of dose and intensity parameters is essential to compare efficacious treatment programs and to understand variability in treatment response across individuals with aphasia. The MDAF is a promising tool, though detailed treatment intensity remains a challenging construct to measure, particularly at the level of the episode. Clinical researchers interested in dose and intensity and authors of evidence-based therapy approaches must continue to work to define and describe active ingredients within therapy approaches.

Embracing virtual reality in rehabilitation of post-stroke aphasia.

About one-third of stroke survivors experience aphasia, i.e., language dysfunction caused by brain damage. Aphasia affects not only a person's ability to communicate, but it often leads to the inability to return to work, loss of close relationships, diminished quality of life, negative self-perception, and depression. Yet persons with aphasia are globally underserved due to limited access to resources, which limits their chance for recovery. Immersive virtual reality (VR) has the potential to solve this problem and deliver efficient, personalized treatments to millions of people worldwide who need access to rehabilitation services or more flexibility in treatment delivery. To reduce the global burden of stroke experts recommend taking bold, pragmatic actions across all four pillars of stroke quadrangle-surveillance, prevention, acute care, and rehabilitation. Embracing immersive VR-based rehabilitation of poststroke aphasia would be one step in that direction.

Post-stroke aphasia rehabilitation using an adapted visual P300 brain-computer interface training: improvement over time, but specificity remains undetermined.

This study aimed to evaluate the efficacy of visual P300 brain-computer interface use to support rehabilitation of chronic language production deficits commonly experienced by individuals with a left-sided stroke resulting in post-stroke aphasia. The study involved twelve participants, but five dropped out. Additionally, data points were missing for three participants in the remaining sample of seven participants. The participants underwent four assessments-a baseline, pre-assessment, post-assessment, and follow-up assessment. Between the pre-and post-assessment, the participants underwent at least 14 sessions of visual spelling using a brain-computer interface. The study aimed to investigate the impact of this intervention on attention, language production, and language comprehension and to determine whether there were any potential effects on quality of life and well-being. None of the participants showed a consistent improvement in attention. All participants showed an improvement in spontaneous speech production, and three participants experienced a reduction in aphasia severity. We found an improvement in subjective quality of life and daily functioning. However, we cannot rule out the possibility of unspecific effects causing or at least contributing to these results. Due to challenges in assessing the patient population, resulting in a small sample size and missing data points, the results of using visual P300 brain-computer interfaces for chronic post-stroke aphasia rehabilitation are preliminary. Thus, we cannot decisively judge the potential of this approach.

Rehabilitation of post-stroke aphasia in Ghana.

Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.

Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects.

Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.

Research hotspots and frontiers of post-stroke aphasia rehabilitation: a bibliometric study and visualization analysis.

Aphasia is a common complication of stroke and is associated with high morbidity and mortality rates. Rehabilitation plays a crucial role in the comprehensive management of post-stroke aphasia and its consequences. However, bibliometric analysis in the field of post-stroke aphasia rehabilitation is still lacking. This study aimed to comprehensively identify assistance networks, analyze research trends, focus on hot and cutting-edge health topics related to post-stroke aphasia rehabilitation, and inform future research guidelines. The Web of Science Core Collection (WoSCC) electronic database was searched from inception to January 4, 2023 to identify studies related to post-stroke aphasia rehabilitation. Bibliometric analysis and visualization of country, institution, journal, author, reference, and keywords were performed using CiteSpace and VOSviewer software. A total of 2,325 papers were included in the analysis, with a progressive increase in the number of articles published each year. The USA was the country with the most publications (809 articles), and the University of Queensland was the institution with the most publications (137 articles). The subject area of post-stroke aphasia rehabilitation is dominated by clinical neurology (882 articles). Aphasiology was the journal with the most publications (254 articles) and the most cited journal (6,893 citations). Worrall L was the most prolific author (51 publications), and Frideriksson J was the most cited author (804 citations). By using bibliometrics, we provided a comprehensive review of studies related to post-stroke aphasia rehabilitation. Future research hotspots on topics related to post-stroke aphasia rehabilitation will mainly focus on the plasticity mechanisms of neurolinguistics networks, language function assessment, language rehabilitation modalities, and patients' rehabilitation needs and participation experiences in post-stroke aphasia. This paper provides systematic information that is worth exploring in the future.

Outcomes from a pilot dose comparison study of naming therapy in aphasia

ABSTRACT Background People with aphasia vary considerably in response to aphasia treatments. Treatment dose is likely to be an important factor in understanding treatment response variability and optimising aphasia recovery; however, there is limited empirical evidence to guide dose prescription in post-stroke aphasia rehabilitation. In the present study, we used a novel approach to personalise dose prescription and explored the effect of dose on treatment response in chronic post-stroke aphasia. Aims Examine the effect of providing personalised doses of a cued picture naming treatment (Kendall et al., 2014) on acquisition and maintenance of picture naming outcomes. Method This pilot study used a multiple-baselines design with follow-up at 4- and 12-weeks with replication across four people with chronic post-stroke anomia. Prior to treatment, a comprehensive battery of cognitive and language tests was completed. Participants then undertook a period of cued picture naming treatment (45-minute sessions, five days per week for three weeks) totalling 15 sessions (11.25 hours). Participants were allocated four picture sets – one each for three treated conditions (low dose, moderate dose, and high dose) and one for an untreated control set. The number of naming opportunities provided per dose condition was calibrated against individuals’ pre-treatment picture naming accuracy and speed. Generalised linear mixed effects models were used to evaluate learning effects during treatment, maintenance of these effects, and dose-response relationships. Outcomes Participants received 99% of prescribed treatment doses (i.e., number of naming opportunities provided over the course of treatment). As anticipated, individual treatment responses varied substantially. Three participants demonstrated significantly improved picture naming accuracy on probed items during treatment, with varying response profiles by participant and dose. All participants were able to name more pictures accurately on a bespoke 298-item object picture naming test following treatment. However, no participant demonstrated significant pre-post treatment gains relative to untreated items, although one person demonstrated improved naming four weeks after treatment for items treated under the high dose condition. Dose-response relationships amongst these participants exhibited a greater number of significant results on naming probes in the high dose condition, possibly suggesting superiority of the high dose condition over lower doses of cued picture naming treatment. Conclusion Modest treatment effects and variable dose-response relationships were observed. We explore the role of dose, cognitive factors such as self-monitoring abilities, and linguistic factors such as underlying lexical-semantic and phonological processing that may have influenced treatment response in these participants. Avenues for future research are identified.

Transcranial Direct-Current Stimulation and Behavioral Training, a Promising Tool for a Tailor-Made Post-stroke Aphasia Rehabilitation: A Review.

Aphasia is an acquired language disorder resulting from damage to portions of the brain which are responsible for language comprehension and formulation. This disorder can involve different levels of language processing with impairments in both oral and written comprehension and production. Over the last years, different rehabilitation and therapeutic interventions have been developed, especially non-invasive brain stimulation (NIBS) techniques. One of the most used NIBS techniques in aphasia rehabilitation is the Transcranial Direct-Current Stimulation (tDCS). It has been proven to be effective in promoting a successful recovery both in the short and the long term after a brain injury. The main strength of tDCS is its feasibility associated with relatively minor side effects, if safely and properly administered. TDCS requires two electrodes, an anode and a cathode, which are generally placed on the scalp. The electrode montage can be either unipolar or bipolar. The main aim of this review is to give an overview of the state of the art of tDCS for the treatment of aphasia. The studies described included patients with different types of language impairments, especially with non-fluent aphasia and in several cases anomia. The effects of tDCS are variable and depend on several factors, such as electrode size and montage, duration of the stimulation, current density and characteristics of the brain tissue underneath the electrodes. Generally, tDCS has led to promising results in rehabilitating patients with acquired aphasia, especially if combined with different language and communication therapies. The selection of the appropriate approach depends on the patients treated and their impaired language function. When used in combination with treatments such as Speech and Language Therapy, Constraint Induced Aphasia Therapy or Intensive Action Treatment, tDCS has generally promoted a better recovery of the impaired functions. In addition to these rehabilitation protocols, Action Observation Therapy, such as IMITAF, appeared to contribute to the reduction of post-stroke anomia. The potential of combining such techniques with tDCS would would therefore be a possibility for further improvement, also providing the clinician with a new action and intervention tool. The association of a tDCS protocol with a dedicated rehabilitation training would favor a generalized long-term improvement of the different components of language.

“LOGOS” in the rehabilitation of post-stroke aphasia

According to the national stroke register of 2019 and 2020, more than 60,000 residents in Uzbekistan are diagnosed with strokes every year, and 1/3 of patients have

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation.

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

Post-stroke aphasia rehabilitation using computer-based Arabic software program: a randomized controlled trial

BackgroundAphasia is considered an acquired communication disorder. Language intervention in aphasia enhances the patient outcomes. Recently, computer programs are developed for the treatment of aphasia. It is an effective and a low-cost therapy choice. The aim of the study was to assess the effectiveness of language therapy using a computer-based Arabic software program for rehabilitation of post-stroke Arabic-speaking aphasic patients in comparison to the conventional language therapy. We conducted a randomized controlled trial with blinded endpoint evaluation. The trial included 50 aphasic patients. They were randomized into either group I or group II to receive 48 therapy sessions using the Arabic software program (group I) or the conventional therapy (group II). The primary outcome was a measure of improvement in language abilities. It was measured using the Arabic version of the Boston Diagnostic Aphasia Examination to detect any significant improvement in the language of both groups in comparison to pre-therapy results. The post-therapy results of both groups were compared to each other to document the effectiveness of the software program.ResultsA total of 105 aphasic patients were screened and 50 subjects were randomized to the intervention groups [40 subjects were males, mean age of the patients: 57.04 years± SD 10.88 for group I and 58.80 years ± SD 11.58 for group II]. The therapy results showed a significant improvement from the baseline in both groups. There was no significant difference in the post-therapy results between group I and group II except for some items whereas group I showed more significant improvement.ConclusionsLanguage therapy using a computer-based Arabic software program was as effective as the conventional therapy in the improvement of language abilities of Arabic-speaking aphasic patients.

MSC virtual e-abstract (ONC)

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Revisiting the Role of Augmentative and Alternative Communication in Aphasia Rehabilitation.

Purpose The purpose of this article is to revisit the role of augmentative and alternative communication (AAC) in poststroke aphasia rehabilitation. The authors' intent is to provide a viewpoint that expands the use of AAC in poststroke aphasia rehabilitation. Specifically, we seek to clarify the role of AAC in restorative and participation approaches to aphasia rehabilitation while also considering the role of AAC in a comprehensive treatment plan. The authors support their viewpoint with citations from both the historic and contemporary literature on aphasia rehabilitation. Conclusions A thought-provoking viewpoint on the role of AAC in poststroke aphasia rehabilitation is proposed. More specifically, the versatility of AAC strategies is reviewed, with an emphasis on how AAC can be used to empower people with aphasia to fully participate and engage in life activities with increased independence. Moreover, we argue that AAC can be viewed as a dual-purpose tool that can simultaneously serve to drive intersystemic reorganization resulting in some improved language performance-and perhaps restoration of language function-while offering a communication alternative during inevitable anomic events.

Rating experience of ICT-delivered aphasia rehabilitation: co-design of a feedback questionnaire

ABSTRACT Background: Speech and language therapy can provide beneficial outcomes in post-stroke aphasia rehabilitation, and intensity is a key component of a successful programme. Information and communication technologies (ICT) may offer an option for the provision of intensive rehabilitation but the views of those undertaking this mode of rehabilitation must be considered to ensure motivation and adherence with self-administered rehabilitation. There is no consensus measure for recording feedback from people with aphasia on user experience of ICT-delivered aphasia rehabilitation. This paper reports on the collaborative development of a feedback questionnaire with people with aphasia for people with aphasia. Aims: There are three research aims (i) to develop a questionnaire to facilitate feedback on ICT-delivered aphasia rehabilitation by collaboratively working with people with aphasia in the design process, (ii) to describe the development process and the co-design techniques employed, and (iii) to explore the experiences of co-designers in the development process. Methods & Procedures: Using public patient involvement (PPI) in health research, a co-design process was employed throughout 6 group workshops. Six people with aphasia (43 to 76 years of age) with a range of aphasia severities (Western Aphasia Battery Aphasia Quotient range 24.4–83) engaged in the co-design process. The final product, an online user feedback questionnaire, was developed. Individual exit interviews were carried out with the co-designers after the workshops, and a thematic analysis of the interview data was completed. Outcomes & Results: The final questionnaire provides an outcome measure that investigates: cognitive workload, satisfaction, programme functionality and ease of use, and the level of assistance required when engaging in ICT-delivered aphasia rehabilitation. It is presented as an online survey in an aphasia-accessible format. Following the co-design experience, four themes were identified within the exit interviews: Group Dynamics, Balance of Complexity of Tasks, Reflection on Abilities and Positive Experience. The co-design process provided opportunities for social interaction with other people with aphasia and allowed co-designers to reflect on their own abilities. The workshops were considered accessible and facilitated their engagement in the co-design process. The process was inclusive and the co-designers reported feeling comfortable about contributing in the workshops and this was also noted in their feedback in the individual exit interviews. Conclusion: People with aphasia can, and should, be included in all stages of the aphasia research process and especially in the development and design of evaluation measures for use by people with aphasia.

Assessment of the quality and content of clinical practice guidelines for post-stroke rehabilitation of aphasia.

The purpose of this study was to evaluate the quality of guidelines for rehabilitation of post-stroke aphasia using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument and identify consistency of different guidelines. A systematic search was undertaken from inception to October 2018. Two reviewers independently screened all titles and abstracts, and assessed eligible guidelines using the AGREE-II. Agreement among reviewers was measured by using intra-class correlation coefficient (ICC). From 5008 records screened, 8 guidelines met the inclusion criteria. The quality of guidelines was heterogeneous. Three guidelines were rated high (6.5) across; the highest rated domain was "scope and purpose' (median score 95.8%); the lowest rated domain was "rigor of development' (median score 67.2%). An overall high degree of agreement among reviewers to each domain was observed (ICC ranged from 0.60 to 0.99). The speech language therapy was recommended in 3 guidelines. Four guidelines described group treatment was beneficial for the continuum of care. However, other therapies for aphasia varied in the level of detail across guidelines. Our study indicated the quality of guidelines for post-stroke aphasia needed to be improved. Moreover, the treatment recommendations of aphasia existed discrepancy among the included guidelines. Therefore, it is suggested to pay more attention on the rigor of methodology and applicability during the process of the formulation of guideline. Future research should focus on the effectiveness, intensity, and duration of treatment measures.

Poststroke Aphasia Rehabilitation: Why All Talk and No Action?

There is ample agreement in the scientific literature, across diverse areas of study, that suggests that language and movement are interrelated. In particular, it is widely held that the upper limb and hand play a key role in language use. Aphasia, a common, disabling language disorder frequently associated with stroke, requires new restorative methods. A combinatorial hand-arm-language paradigm that capitalizes on shared neural networks may therefore prove beneficial for aphasia recovery in stroke patients and requires further exploration.

The clinical management and rehabilitation of post stroke aphasia in Italy: evidences from the literature and clinical experience.

Aphasia is one of the most devastating symptoms in stroke survivors and severely affects patients' communication, quality of life, and social interactions. Several factors are critical to the prediction of aphasia recovery, including acute stroke management and subsequent language rehabilitation. A comprehensive assessment of language skills with appropriate instruments in different phases of post stroke months and years is needed in patients, in order to monitor their language improvement and to guide speech therapies over time. Beyond spontaneous recovery, the effects of speech and language therapy in terms of time and dosage of administration during the course of post stroke aphasia are still under investigation. Data point to its efficacy either in the early or in the chronic (> 6months) post stroke phase, with greater effects if intensive treatments are provided. Tailored interventions for single patients' aphasia characteristics are recommended, with different levels of evidence for specific techniques. Ongoing trials and meta-analyses will be useful in order to change the allocation of rehabilitation resources for patients with aphasia.

Abstract TP175: Changes in Brain Network After High Frequency Repetitive Transcranial Magnetic Stimulation Based on Brain Activation During Language Performance in Chronic Stroke Patients With Non-Fluent Aphasia

Introduction: In post-stroke aphasia rehabilitation, repetitive transcranial stimulation (rTMS) aimed to reinforce the activity of the brain regions in the left hemisphere. In the present study, we performed functional near-infrared spectroscopy (fNIRS) with excitatory rTMS treatment for selection of the most appropriate application of stimulation and detection of the changes in cortical brain network. The purpose of this study is to assess the changes in brain network after high frequency rTMS in post-stroke non-fluent aphasia patients. Methods: Five right-handed patients with post-stroke non-fluent aphasia were included in this study. The most activated area of left hemisphere in fNIRS analysis was selected for stimulation. 34 channels were set by arranging 12 sensors and detectors at intervals of 3cm covering Broca and Wernicke areas. Excitatory rTMS (10Hz, 800 stimuli, 100% of resting motor threshold, tangential to scalp) at the most activated area with navigation system was done in combination with 30 minutes’ speech therapy for 10 consecutive days. Western aphasia battery (WAB) and fNIRS evaluation before (T0), right after 10 sessions of treatment (T1) and 2 months after the last treatment session (T2) were done. The changes in brain network were analyzed by the graph theoretical approach. Results: The scores from subtests in WAB have increased after excitatory rTMS combined with speech therapy in all subjects (Figure 1). The thresholded correlation in the area of stimulation became higher in all patients. The changes of network parameters such as global efficiency and small-worldness in Broca and Wernicke area was significant after rTMS in all patients. Conclusion: Aphasia quotient and scores from all subtests in WAB have increased significantly after targeted excitatory rTMS combined with speech therapy in all subjects. The efficiency in brain language network has been changed after excitatory rTMS.

Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review.

Transcranial direct current stimulation (tDCS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown the effectiveness of tDCS in improving language recovery in post-stroke aphasia. However, this innovative technique is not currently used in routine speech and language therapy (SLT) practice. This systematic review aimed to summarise the role of tDCS in aphasia rehabilitation. We searched MEDLINE via PubMed and Scopus on October 5, 2018 for English articles published from 1996 to 2018. Eligible studies involved post-stroke aphasia rehabilitation with tDCS combined or not with SLT. We retained 5 meta-analyses and 48 studies. Among the 48 studies, 39 were randomised controlled trials (558 patients), 2 prospective studies (56 patients), and 5 case studies (5 patients). Two articles were sub-analyses of a randomised clinical trial. Methods used in these studies were heterogeneous. Only 6 studies did not find a significant effect of tDCS on language performance. As compared with earlier meta-analyses, the 2 latest found significant effects. Evidence from published peer reviewed literature is effective for post-stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the subacute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies.