Timing of transcranial direct current stimulation (tDCS) combined with speech and language therapy (SLT) for aphasia: study protocol for a randomized controlled trial

Sameer A Ashaie, Samantha Engel, Leora R Cherney, Sameer A Ashaie, Samantha Engel, Leora R Cherney

Abstract

Background: Studies suggest that language recovery in aphasia may be improved by pairing speech-language therapy with transcranial direct current stimulation. However, results from many studies have been inconclusive regarding the impact transcranial direct current stimulation may have on language recovery in individuals with aphasia. An important factor that may impact the efficacy of transcranial direct current stimulation is its timing relative to speech-language therapy. Namely, online transcranial direct current stimulation (paired with speech-language therapy) and offline transcranial direct current stimulation (prior to or following speech-language therapy) may have differential effects on language recovery in post-stroke aphasia. Transcranial direct current stimulation provided immediately before speech-language therapy may prime the language system whereas stimulation provided immediately after speech-language therapy may aid in memory consolidation. The main aim of this study is to investigate the differential effects of offline and online transcranial direct stimulation on language recovery (i.e., conversation) in post-stroke aphasia.

Methods/design: The study is a randomized, parallel-assignment, double-blind treatment study. Participants will be randomized to one of four treatment conditions and will participate in 15 treatment sessions. All groups receive speech-language therapy in the form of computer-based script practice. Three groups will receive transcranial direct current stimulation: prior to speech-language therapy, concurrent with speech-language therapy, or following speech-language therapy. One group will receive sham stimulation (speech-language therapy only). We aim to include 12 participants per group (48 total). We will use fMRI-guided neuronavigation to determine placement of transcranial direct stimulation electrodes on participants' left angular gyrus. Participants will be assessed blindly at baseline, immediately post-treatment, and at 4 weeks and 8 weeks following treatment. The primary outcome measure is change in the rate and accuracy of the trained conversation script from baseline to post-treatment.

Discussion: Results from this study will aid in determining the optimum timing to combine transcranial direct current stimulation with speech-language therapy to facilitate better language outcomes for individuals with aphasia. In addition, effect sizes derived from this study may also inform larger clinical trials investigating the impact of transcranial direct current stimulation on functional communication in individuals with aphasia.

Trial registration: ClinicalTrials.gov NCT03773406. December 12, 2018.

Keywords: Anodal; Aphasia; Cathodal; Randomized controlled trial; Speech-language therapy; Stroke; Transcranial direct current stimulation; tDCS.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Treatment timeline by tDCS condition. A tDCS concurrent with the first 20 min of SLT, B tDCS prior to SLT, C tDCS post-SLT, and D sham tDCS (only SLT)
Fig. 2
Fig. 2
Flowchart of the study timeline. Schematic diagram of the study protocol
Fig. 3
Fig. 3
Example of target electrode location. Subjects’ heads are co-registered with MR images in a 3-D space to identify target location for the tDCS stimulation site. The red dot denotes the location of the target tDCS electrode
Fig. 4
Fig. 4
The AphasiaScripts software. A Example of a single conversational sentence. The highlighted word reflects the word that is being read aloud by the participant. B Example of a full conversation that participant practices with PAT (virtual therapist) and YOU (participant). Highlighted sentences reflect what the participant is practicing

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