Treatment Of Non-fluent Aphasia Research Articles

Effects of repetitive transcranial magnetic stimulation combined with music therapy in non-fluent aphasia after stroke: A randomised controlled study.

Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. To investigate the clinical efficacy of low-frequency rTMS combined with music therapy on language function and depression in patients with non-fluent aphasia after stroke. A single-blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non-fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. Our preliminary randomised controlled study indicates that low-frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non-fluent aphasia patients after stroke. What is already known on this subject Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non-fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge This is one of the first randomised control trials to investigate whether the clinical efficacy of low-frequency rTMS combined music therapy for non-fluent aphasia is better. The findings show that low-frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work? Low-frequency rTMS combined music therapy may be a better method for treatment of non-fluent aphasia.

Melodic intonation therapy for non-fluent aphasia after stroke: A clinical pilot study on behavioral and DTI findings

Music-based melodic intonation therapy (MIT) has shown promise as a treatment for non-fluent aphasia after stroke. This trial compared the efficacy of music-based MIT and speech therapy (ST) in aphasia, focusing on arcuate fasciculus connectivity in brain structural and language ability scores. A total of 62 patients were enrolled, of whom 40 completed the trial. The experimental group received MIT for 30min/d, five days per week for four weeks, while the control group received ST with the same dose. The BDAE and fMRI-DTI were performed at T0 and T1. The music-based MIT group demonstrated better language levels. DTI showed that FA, FN, and path length of the MIT group in the right hemisphere were significantly increased. Music-based MIT had positive effects on reorganization and activation of arcuate fasciculus in aphasia after stroke. This research is funded by NSFC No. T2341003 and No.2020CZ-10. Clinical Trials ChiCTR2000037871. Ethics approval number: 2020-013-1.

Transcranial magnetic stimulation for the treatment of non-fluent aphasia in stroke survivors

Objective To evaluate the safety and effectiveness of repeated transcranial magnetic stimulation (rTMS) for treating non-fluent aphasia after stroke. Methods Forty-five stroke survivors with non-fluent aphasia were randomly divided into a 0.5 Hz group, a 1 Hz group and a sham group, each of 15. In addition to routine linguistic training, the three groups were given rTMS over the inferior frontal gyrus of the right hemisphere at the corresponding frequency or sham stimulation. Before as well as 5 and 10 days after the treatment, all of the subjects were evaluated using the Chinese version of the Western Aphasia Battery (WAB). The occurrence of adverse events was also observed. Results Before treatment, no significant differences were observed in the groups′ average aphasia ratio, spontaneous speech, listening comprehension, retelling and naming using the WAB. After 5 and 10 days significant increases were observed in the average WAB scores of all three groups, but the listening comprehension of the 0.5 Hz group was significantly better than that of the sham group 10 days later, as was the spontaneous speech of the 1 Hz group. Conclusion rTMS at either 1 Hz or 0.5 Hz can improve the linguistic functioning of stroke survivors with non-fluent aphasia. Both 0.5 Hz and 1 Hz rTMS are safe, but the latter is more effective. Key words: Transcranial magnetic stimulation; Stroke; Aphasia; Safety; Effectiveness

The effects of low-frequency transcranial magnetic stimulation combined with hyperbaric oxygen in the treatment of non-fluent aphasia

Objective To investigate the effect of repeated application of low-frequency transcranial magne-tic stimulation (rTMS) when combined with hyperbaric oxygen (HBO) in the treatment non-fluent aphasia after a stroke. Methods Forty-eight stroke survivors with non-fluent aphasia were randomly assigned to a control group, an HBO group or an observation group, each of 16. All received conventional rehabilitation therapy consisting of drug therapy, speech training and conventional physical exercises, while the HBO and observation groups were additionally given HBO and rTMS combined with HBO respectively. The 1 Hz rTMS was applied over the Broca′s homologues of the unaffected hemisphere. Before and after 4 weeks of treatment, the Western Aphasia Battery (WAB) was used to evaluate the subjects′ language function and the Modified Barthel Index (MBI) was used to assess their ability in the activities of daily living. Results There was no significant difference in the average WAB scores among the three groups before the treatment. After 4 weeks of treatment the average WAB and MBI scores of the HBO group and the observation group had improved significantly, and there was then a significant difference among the three groups. The observation group was performing significantly better than the HBO group and the control group in spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score. Pairwise comparisons showed that the observation group′s average WAB score, spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score were the best, followed by those of the HBO group and then those of the control group. All of the differences were statistically significant. Conclusions Low-frequency rTMS combined with HBO can significantly improve the language function and the quality of life of patients with non-fluent aphasia. Such combined therapy is worthy of clinical promotion and application. Key words: Transcranial magnetic stimulation; Hyperbaric oxygen; Stroke; Non-fluent aphasia

Modified Melodic Intonation Therapy for Acquired Non-Fluent Aphasia

For decades Melodic Intonation Therapy (MIT) has shown good potential within the aphasia population, yet has seldom been used as a frontline treatment, rather placed within a myriad of treatment techniques utilized during aphasia therapy. Debate continues regarding the mechanisms of change from MIT, both therapeutically and neurologically. Modified Melodic Intonation Therapy (MMIT) has developed through the work of Music Therapists and, as the main focus of treatment for non-fluent aphasia, can be an effective means of language re-acquisition for improved speech production. Clinical results from 7 clients with chronic non-fluent aphasia who received MMIT are discussed.

Speak along without the song: what promotes fluency in people with aphasia?

ABSTRACTBackground: Melodic intonation therapy (MIT) is a widely used treatment for nonfluent aphasia that builds upon a number of musical elements in order to ultimately improve generative language. These include intoning syllables on different pitches, using a metrically regular speech rhythm, and the clinician and patient producing phrases in unison. Studies have investigated which of these musical elements might be the most clinically facilitating, but important differences in methodology and results across studies leave some questions unanswered. In particular, the relative roles of intoning and unison production remain unclear.Aims: The present study examined these elements in isolation and in combination.Methods & Procedures: Twelve people with aphasia (PWA) and 10 control participants sang and rhythmically spoke unfamiliar song lyrics in unison with a recording and by themselves. A subset of eight of the PWA returned for post-hoc testing to evaluate singing familiar lyrics from memory, and propositional speech. Across all tasks, productions were evaluated for syllable accuracy.Outcomes & Results: On average, PWA benefited from unison over solo production and from rhythmic speech over singing when repeating unfamiliar lyrics. They did show a benefit of singing when producing familiar lyrics from memory, but this post-hoc task did not control for syllable duration or task order. Within-group correlations indicated that those with more severe apraxia of speech, worse single-word auditory comprehension, and poorer repetition ability benefited the most from unison production. Those with better sentence-level auditory comprehension and poorer performance on a perceptual rhythm test tended to benefit more from singing compared to rhythmically speaking unfamiliar lyrics.Conclusions: Unison production is an important element for promoting fluency in many PWA, and perhaps especially for those for whom MIT is considered an appropriate treatment option. However, some candidates for MIT are hindered by the inclusion of even moderately complex melodic information, indicating that this factor should be considered when customizing or adapting the therapy. Finally, PWA who show a striking improvement in fluency when singing familiar songs will not necessarily benefit from singing when the aim is to produce new lyrics or propositional content.

Effective music therapy techniques in the treatment of nonfluent aphasia

In music therapy for nonfluent aphasia patients who have difficulty producing meaningful words, phrases, and sentences, various benefits of singing have been identified: strengthened breathing and vocal ability, improved articulation and prosody of speech, and increased verbal and nonverbal communicative behaviors. This paper will introduce these various techniques used in clinical music therapy, and summarize findings based on our recent study to illustrate the strength of different techniques emphasizing rhythm, pitch, memory, and vocal/oral motor components dealing with different symptoms. The efficacy of each component is enhanced or diminished by the choice of music and the way it is interactively delivered. This indicates that neural mechanisms underlying speech improvement vary greatly with available acoustic and social cues in aphasic brain.

A randomized, double-blind, placebocontrolled study of bromocriptine in nonfluent aphasia

We carried out a double-blind and placebo-controlled study of the efficacy of bromocriptine in the treatment of nonfluent aphasia. Seven patients received bromocriptine (up to 60 mg/d) and an identical placebo in a randomized order. End points were the number of content words, content units, and pauses > 3 seconds during the description of a figure; verbal naming; and verbal fluency. There were no significant benefits of bromocriptine over placebo in any of the variables examined.