Effects of Neuronavigated Theta Burst Stimulation in Therapy of Post-stroke Aphasia

March 26, 2026 updated by: Katarzyna Polanowska, Institute of Psychiatry and Neurology, Warsaw
Aphasia is an impairment in the ability to express and/or understand language, commonly observed after stroke to the language dominant (left) hemisphere. Despite natural tendency to spontaneous functional recovery in the first months post stroke and language improvement due to application of behavioral speech and language therapy (SLT), many aphasic patients do not achieve satisfactory level of verbal communication. The aim of the planned study is to explore the potential of the noninvasive repetitive Transcranial Magnetic Stimulation (rTMS) as a therapeutic tool for aphasia in addition to traditional behavioral therapy. In case of aphasia, studies on therapeutic effectiveness of rTMS aim to increase the activity of the language-dominant left cerebral hemisphere, which may be achieved in an indirect manner by inhibiting the activity of the opposite (right) hemisphere or in a direct manner by increasing the excitability of preserved language areas in the left hemisphere. In our study, we plan to administer the newest form of rTMS called Theta Burst Stimulation (TBS), which is safer than the conventional rTMS, even when used in the perilesional area. Computer-based neuronavigation system will be implemented to precisely localize stimulation targets, control administration of stimuli during rTMS sessions, and evaluate differences between participants regarding deviations from established stimulation points. 45 patients (all right-handed, polish native speakers, aged 18-75 years, diagnosed with non-fluent aphasia) will be enrolled in a randomized, double-blind, sham-controlled trial. Subjects will be randomly assigned to one of the three groups: 1) a group with excitatory intermittent TBS of the left hemisphere (iTBS group), 2) a group with inhibitory continuous TBS of the right hemisphere (cTBS group), 3) a group with sham TBS (sTBS group as a control group). Specific forms of stimulation will be carried out for three consecutive weeks (Monday to Friday; a total of 15 stimulation sessions). Immediately after each session of the stimulation, patients will undergo individual SLT. Assessment of language functioning will be carried out three times: before and after the therapy period, and 3 months after its completion. Results of the study will broaden knowledge about hemispherical mechanisms of language and speech recovery after stroke and provide insight into possibilities of their modulation for the purpose of post-stroke rehabilitation.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

45

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Poland
    • Masovian Voivodeship
      • Warsaw, Masovian Voivodeship, Poland
        • Recruiting
        • Institute of Psychiatry and Neurology
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • First-ever left middle cerebral artery ischemic stroke (brain damage localization confirmed by magnetic resonance imaging, MRI)
  • 3 or more months from the onset of stroke
  • Non-fluent aphasia (confirmed in the BDAE test) with functional communication difficulties ranging from mild to significant (grades from 2 to 4 in ASRS), marked difficulties in naming, and relatively preserved everyday speech comprehension
  • Native Polish speaker
  • Right-handedness prior to stroke
  • Signing of the informed consent for the participation in the study.

Exclusion Criteria:

  • Psychiatric and/or neurological comorbidity (e. g. dementia, depressive disorder, alcohol dependence)
  • Diagnose of epilepsy or epileptic changes in EEG, also frequent losses of consciousness of unclear etiology which might suggest epileptic seizures
  • History of any neurosurgical procedure around the head area
  • 1.5 T MRI examination contraindications (metal elements in the body, e. g. implantable cardioverter-defibrillator, deep brain stimulation devices; claustrophobia)
  • Regular intake of medication that could affect cortical excitability (e. g. antiepileptic or antipsychotic drugs, antidepressants, benzodiazepines) or medication influencing neuroplastic processes (e. g. dopamine)
  • Significant cognitive impairment limiting patient's cooperation during assessment and behavioral aphasia therapy
  • Visual deficits significantly hindering the perception of therapeutic tasks presented visually on a computer's screen
  • New neurological episode (e. g. another brain stroke) or somatic illness (e. g. COVID-19) during the cycle of the therapy, requiring its interruption.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intermittent TBS (iTBS) of the left hemisphere plus behavioral aphasia therapy
15 sessions of 200-second of iTBS over the pars triangularis of Broca's area in the left hemisphere (BA 45), preceding 45-minutes of behavioral aphasia therapy.
Device: Noninvasive transcranial brain stimulation: excitatory iTBS
600 pulses (3 pulses at 50 Hz given every 200 milliseconds in 2-second trains at 10-second intervals, delivered at 80% of active motor threshold) generated by Magstim Super Rapid2 stimulator equipped with a figure-of-eight coil applied over BA 45 Device: Magstim Co., Wales, UK.
Other Names:
  • Magstim Super Rapid2
Behavioral: Individual speech-language therapy (SLT)
45 minutes training tailored to every patient's deficits, abilities and needs. Exercises used during each therapeutic session include: expressions tasks (naming and sentence building), complex utterances comprehension tasks, reading and writing exercises. Training is administered using paper-and-pencil tasks and computerized aphasia therapy program AfaSystem (Harpo sp.zoo, Poznań, Poland).
Experimental: Continuous TBS (cTBS) of the right hemisphere plus behavioral aphasia therapy
15 sessions of 40 seconds of cTBS over the pars triangularis of the right inferior frontal gyrus (BA 45 homologue), preceding 45-minutes of behavioral aphasia therapy.
Behavioral: Individual speech-language therapy (SLT)
45 minutes training tailored to every patient's deficits, abilities and needs. Exercises used during each therapeutic session include: expressions tasks (naming and sentence building), complex utterances comprehension tasks, reading and writing exercises. Training is administered using paper-and-pencil tasks and computerized aphasia therapy program AfaSystem (Harpo sp.zoo, Poznań, Poland).
Device: Noninvasive transcranial brain stimulation: inhibitory cTBS
600 pulses (3 pulses at 50 Hz, repeated at 5 Hz, delivered at 80% of active motor threshold) generated by Magstim Super Rapid2 stimulator equipped with a figure-of-eight coil applied over BA 45 homologue Device: Magstim Co., Wales, UK.
Other Names:
  • Magstim Super Rapid2
Sham Comparator: Sham TBS (sTBS) of the left hemisphere plus behavioral aphasia therapy
15 sessions of sham TBS over the pars triangularis of Broca's area in the left hemisphere (BA 45), preceding 45-minutes of behavioral aphasia therapy.
Behavioral: Individual speech-language therapy (SLT)
45 minutes training tailored to every patient's deficits, abilities and needs. Exercises used during each therapeutic session include: expressions tasks (naming and sentence building), complex utterances comprehension tasks, reading and writing exercises. Training is administered using paper-and-pencil tasks and computerized aphasia therapy program AfaSystem (Harpo sp.zoo, Poznań, Poland).
Device: Sham TBS simulating left hemispheric iTBS
Sham TMS coil positioned exactly like an active TMS coil resulting in a very good approximation of the auditory effects Device: Magstim Co., Wales, UK.
Other Names:
  • Magstim Super Rapid2

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from pre-treatment assessment in the performance on a picture naming task
Time Frame: Pre-treatment assessment (within 2 days before starting the intervention), post-treatment assessment (within 2 days of completing the 15 days intervention)
Total number of correctly named items (assessed: accuracy and speed of naming) from a set of 250 visually presented objects (200 noun names and 50 verb names; stimuli included in the set are diversified with regard to the articulation difficulty of corresponding words and their usage frequency in everyday speech).
Pre-treatment assessment (within 2 days before starting the intervention), post-treatment assessment (within 2 days of completing the 15 days intervention)
Change from pre-treatment in the performance on the picture naming task at 3 months post-therapy (follow up assessment)
Time Frame: Pre-treatment and 3 months follow-up (post-treatment) assessment
Total number of correctly named items from a set of 250 visually presented objects.
Pre-treatment and 3 months follow-up (post-treatment) assessment
Change from post-treatment in the performance on the picture naming task at 3 months post-therapy
Time Frame: Post-treatment and 3 months follow-up assessment
Total number of correctly named items from a set of 250 visually presented objects.
Post-treatment and 3 months follow-up assessment
Change from pre-treatment assessment in the performance on a scene description task of three visually presented scenes
Time Frame: Pre-treatment assessment, post-treatment assessment (within 2 days of completing the 15 days intervention)
(assessed: length and correctness of utterances).
Pre-treatment assessment, post-treatment assessment (within 2 days of completing the 15 days intervention)
Change from pre-treatment in the scene description task at 3 months post-therapy
Time Frame: Pre-treatment and 3 months follow-up
Oral description of three visually presented scenes (assessed: length and correctness of utterances).
Pre-treatment and 3 months follow-up
Change from post-treatment in the scene description task at 3 months post-therapy
Time Frame: Post-treatment and 3 months follow-up
Oral description of three visually presented scenes (assessed: length and correctness of utterances).
Post-treatment and 3 months follow-up
Change from pre-treatment on the semantic fluency task
Time Frame: Pre-treatment and post-treatment (within 2 days of completing the 15 days intervention)
Producing within a minute as many words as possible from 3 semantic categories: animals, fruit, clothes; assessed: total number of correctly generated items.
Pre-treatment and post-treatment (within 2 days of completing the 15 days intervention)
Change from pre-treatment on the semantic fluency task at 3 months post-therapy
Time Frame: Pre-treatment and 3 months follow-up
Total number of correctly generated items such as animals, fruits, clothes.
Pre-treatment and 3 months follow-up
Change from post-treatment on the semantic fluency task at 3 months post-therapy
Time Frame: Post-treatment and 3 months follow-up
Total number of correctly generated items such as animals, fruits, clothes.
Post-treatment and 3 months follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Communication Effectiveness Index (CETI)
Time Frame: Pre-treatment, post-treatment (within 2 days of completing the 15 day intervention) and on 3-month follow-up
A questionnaire to complete by researcher and family member/caregiver. Contains descriptions of ten communication situations, patients' performance in each of them is assessed on a Likert-type scale (from 0 to 7). Higher score means better functional communication.
Pre-treatment, post-treatment (within 2 days of completing the 15 day intervention) and on 3-month follow-up

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
The Polish version of short form of the Boston Diagnostic Aphasia Examination (BDAE)
Time Frame: Screening appointment (pre-enrollment assessment)
Assesses the linguistic skills of adults with aphasia. This provides information for the diagnosis of the type of aphasia. Includes the six-point Goodglass and Kaplan's Aphasia Severity Rating Scale (ASRS; 0-5 points - lower score means more severe language impairment).
Screening appointment (pre-enrollment assessment)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Institute of Psychiatry and Neurology, Warsaw

Investigators

  • Principal Investigator: Katarzyna E Polanowska, PhD, Institute of Psychiatry and Neurology, Warsaw, Poland

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 2, 2022

Primary Completion (Estimated)

December 1, 2027

Study Completion (Estimated)

December 1, 2027

Study Registration Dates

First Submitted

March 22, 2022

First Submitted That Met QC Criteria

March 22, 2022

First Posted (Actual)

March 31, 2022

Study Record Updates

Last Update Posted (Actual)

March 31, 2026

Last Update Submitted That Met QC Criteria

March 26, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IPiN_KP01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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