tDCS and Aphasia Therapy in the Chronic Phase After Stroke
- Conditions
- Aphasia Following Cerebral InfarctionAphasia Following Nontraumatic Intracerebral Hemorrhage
- Interventions
- Procedure: Aphasia therapyProcedure: tDCS
- Registration Number
- NCT03305614
- Lead Sponsor
- University Ghent
- Brief Summary
This study evaluates the neuromodulatory effect of combined tDCS and aphasia therapy in patients in the chronic phase after stroke. Half of the participants will receive aphasia therapy and tDCS, the other half will receive aphasia therapy and sham-tDCS.
- Detailed Description
Aphasia is present in about one third of all stroke patients in the chronic phase. The first few months after stroke, considerable spontaneous recovery is initiated, including neuronal plasticity and reorganization processes. Language recovery in aphasic stroke patients involves reorganization of brain functions. Longitudinal fMRI studies reveal that the right hemisphere shows increased activity at different times in the recovery process, but in the long-term is correlated with poorer performance. Left re-lateralization, if possible, seems to be the most effective in restoring language function. For a large subgroup of patients, aphasia therapy is not sufficient to resolve language deficits and not all patients are capable to endure intensive aphasia therapy. Therefore, non-invasive techniques (NIBS) such as transcranial direct current stimulation (tDCS) are currently explored as an add-on treatment to improve or accelerate therapy outcomes. tDCS is a painless and safe stimulation tool that modulates cortical excitability through weak polarizing currents (1 mA - 2 mA) between two electrodes. These weak currents are thought to induce a subthreshold shift of resting membrane potentials towards depolarization or hyperpolarization. The effects of stimulation depend on the polarity of the applied current relative to the axonal orientation. It has been found that tDCS not only triggers immediate aftereffects, but also long-lasting effects that persist beyond the stimulation time, even for up to 12 months. It was suggested that long-term potentiation (LTP) and long-term depression (LTD) might be responsible for these long-term effects, however the precise physiologic mechanisms of action are not yet fully understood.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 25
- Diagnosed with mild to moderate aphasia (Token Test Score between 7 and 40) after a first left hemispheric ischemic or hemorrhagic stroke
- Inclusion > 6 months post-stroke
- Age 18 - 85 years
- Being right-handed (> +8 on the questionnaire for handedness, Van Strien)
- Mothertongue: Dutch
- Imaging (CT or MRI) prior to inclusion (in patient file), standard of care in the acute phase
- Signed Informed Consent (attachment 1)
- History of other diseases of the central nervous system, psychological disorders and (developmental) speech and or language disorders
- Serious non-linguistic, cognitive disorders (as documented in the patients' medical history and inquired in the anamneses)
- Prior brain surgery
- Excessive use of alcohol or drugs
- New neurological symptoms between the acute stage and inclusion
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Aphasia therapy and sham-tDCS Aphasia therapy computer-based intensive aphasia therapy as measured by specific linguistic tests Aphasia therapy and tDCS tDCS combined tDCS and aphasia therapy and the effect of conventional intensive aphasia Aphasia therapy and tDCS Aphasia therapy combined tDCS and aphasia therapy and the effect of conventional intensive aphasia
- Primary Outcome Measures
Name Time Method Change in naming performance assessed with the Boston Naming Test baseline, 3 weeks, 3 +/-1 month Naming performance will be assessed with the Boston Naming Test at baseline, immediately following therapy, and after 3 +/- 1 month following treatment
- Secondary Outcome Measures
Name Time Method Change in tolerability assessed with a Visual analogue scale baseline, 2 hour (each session) A Visual analogue scale will asses tolerability before and immediately after each session
Change in spontaneous speech assessed with a Semi-standardized interview of the AAT baseline, 3 weeks, 3 +/- 1 month A Semi-standardized interview of the AAT will assess functional communication at baseline, immediately after therapy, and at 3 +/- 1 month follow-up
Change in ERPs baseline, 3 weeks, 3 +/- 1 month Evoked potentials will be measured at baseline, immediately after treatment and after 3 +/- 1 month
Change in quality of life assessed with the SAQOL-39-NL baseline, 3 weeks, 3+/- 1 month The SAQOL-39-NL will assess the quality of life at baseline, immediately after treatment and at 3 +/-1 month follow-up
Trial Locations
- Locations (1)
University Hospital Ghent
🇧🇪Ghent, East-Flanders, Belgium