Ann Rehabil Med.  2011 Aug;35(4):460-469. 10.5535/arm.2011.35.4.460.

The Factors Associated with Good Responses to Speech Therapy Combined with Transcranial Direct Current Stimulation in Post-stroke Aphasic Patients

• Jung IY
• Lim JY
• Kang EK
• Sohn HM
• Paik NJ

• KMID: 1971710
• DOI: http://doi.org/10.5535/arm.2011.35.4.460

Abstract

OBJECTIVE
To determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke. METHOD: The language function was evaluated using Korean version of Western aphasia battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of aphasia. The factors related with good responses were also checked.
RESULTS
AQ% improved from pre- to post-therapy (14.94+/-6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05).
CONCLUSION
Speech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.

Keyword

Stroke; Aphasia; Speech therapy; Recovery; Transcranial direct current stimulation

MeSH Terms

Aphasia
Brain
Humans
Infarction
Logistic Models
Magnetic Resonance Spectroscopy
Speech Therapy
Stroke

Figure

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  Fig. 1 Flowchart. K-WAB: Korean version of Western aphasia battery.

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  Fig. 2 Initial severity correlated with the natural logarithm of improvement of AQ%. R2=0.286, Pearson correlation coefficient=0.536 (p=0.002). Delta AQ%=post-evaluation AQ%-pre-evaluation AQ%, AQ%: Aphasia quotient %.

Reference

1. Lim SJ, Kim HJ, Nam CM, Chang HS, Jang YH, Kim S, Kang HY. Socioeconomic costs of stroke in Korea: estimated from the Korea national health insurance claims database. J Prev Med Public Health. 2009; 42:251–260. PMID: 19675402.

2. Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR. Residual disability in survivors of stroke--the Framingham study. N Engl J Med. 1975; 293:954–956. PMID: 1178004.

3. Bersano A, Burgio F, Gattinoni M, Candelise L. Aphasia burden to hospitalised acute stroke patients: need for an early rehabilitation programme. Int J Stroke. 2009; 4:443–447. PMID: 19930053.

4. Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry. 1994; 57:202–207. PMID: 8126506.

5. Paolucci S, Antonucci G, Gialloreti LE, Traballesi M, Lubich S, Pratesi L, Palombi L. Predicting stroke inpatient rehabilitation outcome: the prominent role of neuropsychological disorders. Eur Neurol. 1996; 36:385–390. PMID: 8954308.

6. Laska AC, Hellblom A, Murray V, Kahan T, Von Arbin M. Aphasia in acute stroke and relation to outcome. J Intern Med. 2001; 249:413–422. PMID: 11350565.

7. Lazar RM, Antoniello D. Variability in recovery from aphasia. Curr Neurol Neurosci Rep. 2008; 8:497–502. PMID: 18957187.

8. Floel A, Rosser N, Michka O, Knecht S, Breitenstein C. Noninvasive brain stimulation improves language learning. J Cogn Neurosci. 2008; 20:1415–1422. PMID: 18303984.

9. Monti A, Cogiamanian F, Marceglia S, Ferrucci R, Mameli F, Mrakic-Sposta S, Vergari M, Zago S, Priori A. Improved naming after transcranial direct current stimulation in aphasia. J Neurol Neurosurg Psychiatry. 2008; 79:451–453. PMID: 18096677.

10. Gandiga PC, Hummel FC, Cohen LG. Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation. Clin Neurophysiol. 2006; 117:845–850. PMID: 16427357.

11. Lazar RM, Minzer B, Antoniello D, Festa JR, Krakauer JW, Marshall RS. Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke. 2010; 41:1485–1488. PMID: 20538700.

12. Paolucci S, Matano A, Bragoni M, Coiro P, De Angelis D, Fusco FR, Morelli D, Pratesi L, Venturiero V, Bureca I. Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. A matched comparison. Cerebrovasc Dis. 2005; 20:400–406. PMID: 16205059.

13. Brust JC, Shafer SQ, Richter RW, Bruun B. Aphasia in acute stroke. Stroke. 1976; 7:167–174. PMID: 1265809.

14. Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis. 2004; 17:35–43. PMID: 14530636.

15. Lazar RM, Speizer AE, Festa JR, Krakauer JW, Marshall RS. Variability in language recovery after first-time stroke. J Neurol Neurosurg Psychiatry. 2008; 79:530–534. PMID: 17846113.

16. Bakheit AM, Shaw S, Carrington S, Griffiths S. The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke. Clin Rehabil. 2007; 21:941–949. PMID: 17981853.

17. Hillis AE. 'standard' for poststroke aphasia recovery. Stroke. 2010; 41:1316–1317. PMID: 20538691.

18. Nitsche MA, Nitsche MS, Klein CC, Tergau F, Rothwell JC, Paulus W. Level of action of cathodal DC polarisation induced inhibition of the human motor cortex. Clin Neurophysiol. 2003; 114:600–604. PMID: 12686268.

19. Keller SS, Crow T, Foundas A, Amunts K, Roberts N. Broca's area: nomenclature, anatomy, typology and asymmetry. Brain Lang. 2009; 109:29–48. PMID: 19155059.

20. Bennett MR, Hacker PM. Language and cortical function: conceptual developments. Prog Neurobiol. 2006; 80:20–52. PMID: 16982129.

21. Hong JH, Kim SH, Ahn SH, Jang SH. The anatomical location of the arcuate fasciculus in the human brain: a diffusion tensor tractography study. Brain Res Bull. 2009; 80:52–55. PMID: 19463913.

22. Kang EK, Sohn HM, Han MK, Kim W, Han TR, Paik NJ. Severity of post-stroke aphasia according to aphasia type and lesion location in Koreans. J Korean Med Sci. 2010; 25:123–127. PMID: 20052357.

23. Crinion JT, Leff AP. Recovery and treatment of aphasia after stroke: functional imaging studies. Curr Opin Neurol. 2007; 20:667–673. PMID: 17992087.

24. Breier JI, Juranek J, Maher LM, Schmadeke S, Men D, Papanicolaou AC. Behavioral and neurophysiologic response to therapy for chronic aphasia. Arch Phys Med Rehabil. 2009; 90:2026–2033. PMID: 19969164.

25. Harnish SM, Neils-Strunjas J, Lamy M, Eliassen JC. Use of fMRI in the study of chronic aphasia recovery after therapy: a case study. Top Stroke Rehabil. 2008; 15:468–483. PMID: 19008206.

26. Szaflarski JP, Ball A, Grether S, Al-Fwaress F, Griffith NM, Neils-Strunjas J, Newmeyer A, Reichhardt R. Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke. Med Sci Monit. 2008; 14:CR243–CR250. PMID: 18443547.

27. Aftonomos LB, Appelbaum JS, Steele RD. Improving outcomes for persons with aphasia in advanced community-based treatment programs. Stroke. 1999; 30:1370–1379. PMID: 10390309.

28. Fertonani A, Rosini S, Cotelli M, Rossini PM, Miniussi C. Naming facilitation induced by transcranial direct current stimulation. Behav Brain Res. 2010; 208:311–318. PMID: 19883697.

29. Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke. 2010; 41:1229–1236. PMID: 20395612.

30. Fiori V, Coccia M, Marinelli CV, Vecchi V, Bonifazi S, Ceravolo MG, Provinciali L, Tomaiuolo F, Marangolo P. Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects. J Cogn Neurosci. 2011; 23:2309–2323. PMID: 20946060.