Is this enough to have as a protocol for aphasia?
http://www.karger.com/Article/FullText/355499
Noninvasive Brain Stimulation for Treatment of Right- and Left-Handed Poststroke Aphasics
Heiss W.-D.
· Hartmann A.
· Rubi-Fessen I.
· Anglade C.
· Kracht L.
· Kessler J.
· Weiduschat N.
· Rommel T.
· Thiel A.
Cerebrovasc Dis 2013;36:363-372 (DOI: 10.1159/000355499)
Abstract
Background: Accumulating evidence from single case
studies, small case series and randomized controlled trials seems to
suggest that inhibitory noninvasive brain stimulation (NIBS) over the
contralesional inferior frontal gyrus (IFG) of right-handers in
conjunction with speech and language therapy (SLT) improves recovery
from poststroke aphasia. Application of inhibitory NIBS to improve
recovery in left-handed patients has not yet been reported.
Methods:
A total of 29 right-handed subacute poststroke aphasics were randomized
to receive either 10 sessions of SLT following 20 min of inhibitory
repetitive transcranial magnetic stimulation (rTMS) over the
contralesional IFG or 10 sessions of SLT following sham stimulation; 2
left-handers were treated according to the same protocol with real rTMS.
Language activation patterns were assessed with positron emission
tomography prior to and after the treatment; 95% confidence intervals
for changes in language performance scores and the activated brain
volumes in both hemispheres were derived from TMS- and sham-treated
right-handed patients and compared to the same parameters in
left-handers.
Results: Right-handed patients treated with
rTMS showed better recovery of language function in global aphasia test
scores (t test, p < 0.002) as well as in picture-naming performance
(ANOVA, p = 0.03) than sham-treated right-handers. In treated
right-handers, a shift of activation to the ipsilesional hemisphere was
observed, while sham-treated patients consolidated network activity in
the contralesional hemisphere (repeated-measures ANOVA, p = 0.009). Both
left-handed patients also improved, with 1 patient within the
confidence limits of TMS-treated right-handers (23 points, 15.9-28.9)
and the other patient within the limits of sham-treated subjects (8
points, 2.8-14.5). Both patients exhibited only a very small
interhemispheric shift, much less than expected in TMS-treated
right-handers, and more or less consolidated initially active networks
in both hemispheres.
Conclusion: Inhibitory rTMS over the
nondominant IFG appears to be a safe and effective treatment for
right-handed poststroke aphasics. In the 2 cases of left-handed aphasics
no deterioration of language performance was observed with this
protocol. However, therapeutic efficiency is less obvious and seems to
be more related to the dominance pattern prior to the stroke than to the
TMS intervention.
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