Cerebellar tDCS: A Novel Approach to Augment Language Treatment Post-stroke

Rajani Sebastian, Sadhvi Saxena, Kyrana Tsapkini, Andreia V Faria, Charltien Long, Amy Wright, Cameron Davis, Donna C Tippett, Antonios P Mourdoukoutas, Marom Bikson, Pablo Celnik, Argye E Hillis, Rajani Sebastian, Sadhvi Saxena, Kyrana Tsapkini, Andreia V Faria, Charltien Long, Amy Wright, Cameron Davis, Donna C Tippett, Antonios P Mourdoukoutas, Marom Bikson, Pablo Celnik, Argye E Hillis

Abstract

People with post-stroke aphasia may have some degree of chronic deficit for which current rehabilitative treatments are variably effective. Accumulating evidence suggests that transcranial direct current stimulation (tDCS) may be useful for enhancing the effects of behavioral aphasia treatment. However, it remains unclear which brain regions should be stimulated to optimize effects on language recovery. Here, we report on the therapeutic potential of right cerebellar tDCS in augmenting language recovery in SMY, who sustained bilateral MCA infarct resulting in aphasia and anarthria. We investigated the effects of 15 sessions of anodal cerebellar tDCS coupled with spelling therapy using a randomized, double-blind, sham controlled within-subject crossover trial. We also investigated changes in functional connectivity using resting state functional magnetic resonance imaging before and 2 months post-treatment. Both anodal and sham treatments resulted in improved spelling to dictation for trained and untrained words immediately after and 2 months post-treatment. However, there was greater improvement with tDCS than with sham, especially for untrained words. Further, generalization to written picture naming was only noted during tDCS but not with sham. The resting state functional connectivity data indicate that improvement in spelling was accompanied by an increase in cerebro-cerebellar network connectivity. These results highlight the therapeutic potential of right cerebellar tDCS to augment spelling therapy in an individual with large bilateral chronic strokes.

Keywords: aphasia; cerebellar tDCS; resting state fMRI; spelling therapy; stroke.

Figures

Figure 1
Figure 1
Lesion map of SMY.
Figure 2
Figure 2
Back and lateral views of the modeling data of the electric field distributions below the stimulating electrode on the right cerebellum.
Figure 3
Figure 3
Fisher-transformed correlation matrix for the resting state data for SMY (top panel) at time point 1 (TP1: prior to the start of treatment) and time point 2 (TP2: 2-months follow up time point). Control participant's data is shown in the bottom panel. Difference map shows the difference in correlation between the scan for the resting state data. Correlations were assessed across 14 ROIs. Regions are labeled as numbers corresponding to the left and right superior frontal gyrus (SFG; region 1 and 2), superior frontal gyrus_prefrontal cortex (SFG_PFC; region 3 and 4), middle frontal gyrus dorsolateral prefrontal cortex (MFG_DLPC; region 5 and 6), middle temporal gyrus pole (MTG_pole; region 7 and 8), inferior temporal gyrus (ITG; region 9 and 10), fusiform gyrus (FG; region 11 and 12), and cerebellum (region 13 and 14).

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