Recovery From Post-Stroke Aphasia With rTMS Targeting the Anterior Temporal Lobe: Interhemispheric Activation Changes and Lesion-Connectome-Based Predictive Outcomes
University of South Carolina
Summary
This project aims to tailor repetitive Transcranial Magnetic Stimulation (rTMS) target to the clinical profile of post-stroke aphasia, specifically focusing on lexicosemantic impairments, to enhance recovery. Functional Magnetic Resonance Imaging (fMRI) will provide critical insights into the effects of facilitatory versus inhibitory stimulation on interhemispheric balance. Additionally, this study will generate new data on how lesion localization and brain connectivity influence individual responses to rTMS, explaining variability in treatment efficacy.
Description
Background and aims In the United States, 18 to 66% of individuals who experience a stroke will suffer from language impairment, referred to as aphasia. Aphasia profoundly impacts quality of life by restricting participation in social, familial, and professional spheres. While the gold standard for aphasia rehabilitation is Speech and Language Therapy (SLT), it often does not lead to complete recovery. Repetitive Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct Current Stimulation (tDCS) are non-invasive brain stimulation techniques that could enhance post-stroke aphasia recover…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Right-handedness (assesed using the Edinburgh Handedness Inventory) * Native English speakers * Single left hemispheric stroke * Diagnosis of aphasia and lexicosemantic impairments (e.g., anomia, semantic errors in picture naming or spontaneous speech) confirmed by a Speech and Language Pathologist or Physician Exclusion Criteria: * Severely impaired auditory comprehension (WAB Comprehension score of 0 or 1) * Major phonological impairments (defined as \> 2 errors in non-word repetition of one- and two-syllable items on the PALPA, 2) * Contraindications to rTMS (e.g.,…
Interventions
- Devicecontinuous Theta Burst Stimulation
We will use continuous Theta Burst Stimulation (600 pulses, burst frequency at 5 Hz, burst of three pulses at 50Hz) targeting the right ATL
- Deviceintermittent Theta Burst Stimulation
We will use intermittent Theta Burst Stimulation (600 pulses, burst frequency at 5 Hz, burst of three pulses at 50Hz, interval intertrain of 8 sec, 10 pulses in train) targeting the left ATL
- DeviceTranscranial Magnetic Stimulation Sham
We will use sham stimulation using the same coil but flipped over, with the left ATL targeted in half of the participant and the right ATL in the other half. The placebo coil will replicate the auditory sensations produced by active stimulation. In addition, we will use electrical stimulation of the scalp (via electrodes placed over specific muscles) in the Sham group to mimic the sensory effects of active stimulation. Participants will have no prior rTMS experience before inclusion in the protocol.
- BehavioralSemantic Feature Analysis
Participants will receive 30 minutes of Semantic Feature Analysis therapy administered by a Speech and Language Pathologist. On a computer screen, participants will see an image of an object and will be cued to retrieve the object's name by describing various features of the object, including its physical properties, typical location, personal associations, category, use and actions involving the object (Quique et al., 2019).
Location
- McCausland CenterColumbia, South Carolina