Repetitive Transcranial Magnetic Stimulation and Multi-modality Aphasia Therapy for Post-stroke Non-fluent Aphasia

University of Calgary46 enrolled

Overview

Many stroke survivors experience aphasia, a loss or impairment of language affecting the production or understanding of speech. One common type of aphasia is known as non-fluent aphasia. Patients with non-fluent aphasia have difficulty formulating grammatical sentences, often producing short word fragments despite having a good understanding of what others are trying to communicate to them. Speech language pathologists (SLPs) play a central role rehabilitating persons with aphasia and administer therapy in an attempt to improve communication skills. Despite standard therapy, approximately 50% of individuals who experience aphasia acutely continue to have language deficits more than 6 months post-stroke. In most people, Broca's area is dominant in the left side of the brain. Following a left-sided stroke, the right-sided homologue of Broca's area (the pars triangularis), may adopt language function. Unfortunately, reorganizing language to the right side of the brain seems to be less effective than restoring function to the left hemisphere. Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, can be used to suppress activity of specific regions in the right side of the brain to promote recovery of function in the perilesional area. Despite preliminary success in existing studies using rTMS in post-stroke aphasia, there is much work to be done to better understand the mechanisms underlying recovery. Responses to rTMS have been positive, yet heterogenous, which may be related to timing of treatments following stroke.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Interventions

1Hz inhibitory rTMSDEVICE

20 minutes of 1Hz (1200 pulses) repetitive transcranial magnetic stimulation (rTMS) applied by Magstim Rapid 2 stimulator equipped with an airfilm figure-8 coil

1Hz sham rTMSDEVICE

20 minutes of 1Hz (1200 pulses) repetitive transcranial magnetic stimulation (rTMS) applied by Magstim Rapid 2 stimulator equipped with an airfilm figure-8 sham coil.

Multi-Modality Aphasia Therapy (M-MAT)BEHAVIORAL

Participants receive 3.5 hours of intensive speech therapy in small groups delivered by a blinded speech language pathologist and therapy assistant. The objective of M-MAT is to improve word production through shaping of responses (ie. Gradually increasing complexity of spoken targets towards eventual mastery) and social-mediated repetitive practice. Therapists use game-based interactive tasks and rich multi-modal cueing (gestures, written words, drawing, reading words) to improve spoken production and oral communication.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Isolated left middle cerebral artery (MCA) stroke within past 6 months (sub-acute) or more than 6 months ago (chronic) * Stroke type: Ischemic or hemorrhagic * Non-fluent aphasia as determined by the Western Aphasia Battery (Fluency \< 5) * English is first or primary language * Ability to follow 3-step commands Exclusion Criteria: * Prior stroke to the right frontal lobe * Current diagnosis of moderate to severe depression * Diagnosis of any other psychiatric condition * History of other neurologic disorders (e.g., epilepsy, brain tumor) * Contraindication to MRI or TMS (metal in the head or any implanted electrical device) * Has received intensive speech therapy within the past 6 months (\>8 hours per week) * Enrolled in another interventional study

Outcomes

Primary Outcomes

Change from baseline on the Western Aphasia Battery (Revised) Aphasia Quotient within one week of intervention completion

Western Aphasia Battery Aphasia quotient (WAB-AQ) composite score, composed of fluency, spontaneous speech, naming, and comprehension sub-tests. Scores range from 0 to 100, with higher scores indicating better overall speech and language abilities. Positive change from baseline indicates better outcome.

Time frame: Baseline, within 1 week of completing the 10 day intervention

Change from baseline on the Western Aphasia Battery (Revised) Aphasia Quotient at 3 months

Time frame: Baseline and 3-month follow-up

Secondary Outcomes

Trained and Untrained Picture Naming

Number of correctly named pictures from a set of trained nouns, trained verbs, untrained nouns, and untrained verbs.