Can tDCS enhance treatment of aphasia after stroke?

Rachel Holland, Jenny Crinion, Rachel Holland, Jenny Crinion

Abstract

BACKGROUND: Recent advances in the application of transcranial direct current stimulation (tDCS) in healthy populations have led to the exploration of the technique as an adjuvant method to traditional speech therapies in patients with post-stroke aphasia. AIMS: THE PURPOSE OF THE REVIEW IS: (i) to review the features of tDCS that make it an attractive tool for research and potential future use in clinical contexts; (ii) to describe recent studies exploring the facilitation of language performance using tDCS in post-stroke aphasia; (iii) to explore methodological considerations of tDCS that may be key to understanding tDCS in treatment of aphasia post stroke; and (iv) to highlight several caveats and outstanding questions that need to be addressed in future work. MAIN CONTRIBUTION: This review aims to highlight our current understanding of the methodological and theoretical issues surrounding the use of tDCS as an adjuvant tool in the treatment of language difficulties after stroke. CONCLUSIONS: Preliminary evidence shows that tDCS may be a useful tool to complement treatment of aphasia, particularly for speech production in chronic stroke patients. To build on this exciting work, further systematic research is needed to understand the mechanisms of tDCS-induced effects, its application to current models of aphasia recovery, and the complex interactions between different stimulation parameters and language rehabilitation techniques. The potential of tDCS is to optimise language rehabilitation techniques and promote long-term recovery of language. A stimulating future for aphasia rehabilitation!

Figures

Figure 1.
Figure 1.
Summary schematic representation of potential tDCS effects in language performance in relation to normal re-learning after single and repeated interventions protocols (related to Table 1). Solid green line represents normal re-learning curve. Solid vertical red line indicates the potential percentage change in performance that may occur after a single intervention of tDCS. Dashed red line indicates potential performance change over 5 days from repeated tDCS delivered concurrently with treatment. Normal and tDCS-enhanced learning share an equivalent learning profile, however resulting gains post-tDCS may be modified by approximately 25%, with the effects of tDCS persisting for up to 3 weeks. To view this figure in colour, please see the online issue of the Journal.
Figure 2.
Figure 2.
Illustration of potential target sites of stimulation to facilitate naming performance in relation to structural brain damage and the normal naming network in three different patients. The top panel illustrates the extensive bilateral fronto-temporal naming network found in an fMRI study of healthy older particpants (cf. Holland et al., 2011). Activation is overlaid onto a rendered cortical surface from SPM8. In the lower panels of the figure we overlay the normal pattern of brain activation onto three chronic aphasic stroke patients’ individual structural MRI scans. The aim here is to illustrate from left to right for each patient: (1) their structural brain damage within the left hemisphere, (2) the normal naming network overlaid onto their individual brain scan to show the relationship between the lesion damage to the naming network and the target stimulation site (red cross), and (3) the stimulation sites feasible for each patient depending on the proposed target site. Panel A highlights, in two chronic aphasic stroke patients, that structurally intact regions of cortex within the lesioned left hemisphere may serve as potential candidate sites for anodal stimulation to facilitate treatment of anomia in (Ai) Broca's area and (Aii) Wernicke's area. Panel B highlights that when the lesion is has damaged relevant cortices in the left hemisphere perilesional stimulation may not be possible. Therefore, for the two patients illustrated, facilitation of the contralesional hemisphere may be the optimal approach to aid recovery: (Bi) right homologue to Broca's area and (Bii) Wernicke's area. Although not illustrated here, in cases where patients have suffered a large MCA infarct affecting the whole of the left hemisphere and resulted in extremely limited perilesional tissue, stimulation of the contralesional hemisphere would be the sole option. Furthermore, studies of aphasia recovery have successfully used anodal stimulation of the left perilesional hemisphere to elicit positive behavioural outcomes, however the effects of anodal or cathodal stimulation of the right contralesional hemisphere are, as yet unknown, and will be dependent on the theoretical hypotheses of the research. To view this figure in colour, please see the online issue of the Journal.

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