Primary progressive aphasia (PPA) is a disorder characterized by gradual decline in speech-language ability caused by underlying neurodegenerative disease. PPA is a devastating condition that can affect adults as young as their 50's, depriving them of the ability to communicate and function in society. Along with Alzheimer's Disease and other Alzheimer's Disease Related Dementias (AD/ADRD), PPA is now identified earlier and with greater precision. Increasingly, patients and families seek options for behavioral and neuromodulatory treatments to address PPA's devastating effects on communication, prolong speech-language skills, and maximize quality of life. Studies have documented the robust benefits of speech-language telerehabilitation methods for persons with PPA, with in-home treatment resulting in immediate and long-term benefits. This investigation aims to further enhance the potency of these treatment approaches by pairing them with tailored neuromodulatory intervention that targets critical brain networks supporting treatment in each clinical subtype of PPA. The study will evaluate the feasibility and preliminary benefit of home-based transcranial direct current stimulation (tDCS) combined with evidence-based speech-language telerehabilitation methods. tDCS will be delivered to patients in their own homes and site of stimulation will be tailored for each clinical subtype of PPA. This project has the potential to enhance clinical management and rehabilitation for individuals with PPA by establishing the benefit of behavioral and neuromodulatory treatment that is neurobiologically-motivated and accessible for patients and families.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
10
tDCS is a type of non-invasive brain stimulation. 1.5 milliamp (mA) of current will be delivered via electrodes in saline-soaked sponges placed on the left side of the head and right upper arm. The stimulation will be delivered for 20 minutes, 5 times weekly, in the participant's home setting while the participant engages in computer-delivered speech-language training. Sessions are monitored by study personnel.
tDCS is a type of non-invasive brain stimulation. During sham stimulation 1.5 milliamp (mA) of current will be delivered for a brief period and then turned off. Current will be delivered via electrodes in saline-soaked sponges placed on the left side of the head and right upper arm. Sham will be delivered for 20 minutes, 5 times weekly, in the participant's home setting while the participant engages in computer-delivered speech-language training. Sessions are monitored by study personnel.
Participants work on producing spoken and written names of personally relevant target items using a self-cueing hierarchy. Treatment focuses on the use of strategies that capitalize on spared cognitive-linguistic abilities to support word retrieval. The participant completes two (one hour each) teletherapy sessions per week with a clinician plus 30 minutes of additional independent, computer-based practice exercises 3 times per week.
Participants work on producing personally relevant scripts of 4-6 sentences in length. Length and complexity of scripts are individually tailored. The participant completes two (one hour each) teletherapy sessions per week with a clinician targeting clear and accurate script production, script memorization, and conversational usage of scripts. The participant completes 30 minutes of independent, computer-based practice 3 times per week, during which they speak in unison with a video/audio model of a healthy speaker clearly articulating the scripts.
Memory and Aging Center, University of California, San Francisco
San Francisco, California, United States
University of Texas
Austin, Texas, United States
RS-LRT arm: Change in spoken naming
Change in percent correctly named trained/untrained pictures
Time frame: change from pre-treatment to one month and three months after onset of treatment in each phase (stimulation and sham)
RS-VISTA arm: Change in script production accuracy
Change in percent correct, intelligible, scripted words produced for trained/untrained scripts
Time frame: change from pre-treatment to one month and three months after onset of treatment in each phase (stimulation and sham)
Change on Communication Confidence Rating Scale for Aphasia
Change on 10-item Likert-type self-rating scale evaluating communication confidence in different settings for persons with aphasia. A higher score indicates greater confidence.
Time frame: change from pre-treatment to one month and three months after onset of treatment in each phase (stimulation and sham)
Change on Aphasia Impact Questionnaire
Change on Patient Reported Outcome Measure for persons with aphasia; characterizes activities, participation and emotional state/wellbeing using a 5-point pictorial rating scale. A higher score indicates greater impact of aphasia.
Time frame: change from pre-treatment to one month and three months after onset of treatment in each phase (stimulation and sham)
Client Satisfaction Questionnaire
Likert-type scale measuring patient/client satisfaction with intervention. A higher score indicates greater satisfaction.
Time frame: four months after treatment onset
Remotely-supervised Transcranial Direct Current Stimulation (RS-tDCS) Survey
Likert type scale used to capture participants' perceptions regarding the acceptability and potential demand for remotely-supervised tDCS.
Time frame: four months after onset of treatment
Care Partner Survey
Likert-type scale used to characterize care partners' perceptions of the benefits of speech-language treatment.
Time frame: four months after onset of treatment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.