Cerebellar stimulation for Aphasia Rehabilitation

项目摘要 失语症是中风的一种严重并发症。言语和语言治疗（英语：Speech and language treatment）可以帮助恢复 语言功能，但并非所有人都表现出改善。最近的研究表明，经颅直接 电流刺激（tDCS）是一种很有前途的辅助方法，以提高有效性的治疗。tDCS是一个 无创无痛的大脑电刺激据信tDCS增强神经可塑性， 是复苏的基础大多数失语症的tDCS研究都刺激了左半球 地区然而，中风后失语症患者常见的左半球病变会影响脑内的电场， 不可预测的方式，可能会阻止刺激到达与最佳病变相关的病灶周围组织。 复苏我们的工作通过刺激一个新的区域--右侧小脑来解决这个问题。权 小脑与左半球相连，参与各种认知和语言功能， 包括命名，这在失语症患者中经常受到损害。PI之前的研究表明小脑tDCS 是安全的，易于耐受，并改善语言技能在一些中风参与者与失语症。的 拟议的项目将建立在这些发现的基础上，进行随机，双盲，假对照试验， 确定右小脑阴极tDCS治疗卒中后失语症的有效性。 我们将比较15次小脑tDCS治疗结合循证命名障碍的效果。 治疗（语义特征分析，SFA）的患者进行15次假手术联合SFA治疗， 慢性（卒中后至少6个月）失语症。我们将评估小脑tDCS对命名的影响 未经训练的项目，以及对功能性沟通，内容，效率和单词检索的影响， 图片描述和生活质量。该项目还将确定成像和语言生物标志物，以确定 从小脑tDCS和SFA治疗中获益的卒中患者的特征。个体反应 tDCS治疗是高度可变的，很少有人知道如何与成像和语言相关的因素 特征联合收割机以诱导治疗反应性。我们将进行静息态功能磁 磁共振成像（rsfMRI），扩散张量成像（DTI），高分辨率结构成像，以及详细的 在治疗开始前进行语言测试，以确定这些因素是否可以预测对 小脑tDCS和/或SFA。本研究的长期目标是为III期随机 小脑tDCS与假手术同时进行的治疗慢性失语症的对照试验。

Project Abstract Aphasia is a devastating complication of stroke. Speech and language treatment (SLT) can be helpful in restoring language function, but not all individuals show improvement. Recent studies indicate that Transcranial Direct Current Stimulation (tDCS) is a promising adjuvant approach to enhance the effectiveness of SLT. tDCS is a noninvasive, non-painful, electrical stimulation of the brain. It is believed that tDCS boosts neural plasticity that underlies recovery with SLT. A majority of the tDCS studies of aphasia have stimulated the left hemisphere regions. However, left hemisphere lesions common in post-stroke aphasia affect the electrical field in unpredictable ways, potentially preventing stimulation from reaching perilesional tissue associated with optimal recovery. Our work addressed this problem by stimulating a novel region, the right cerebellum. The right cerebellum is connected to the left hemisphere and involved in a variety of cognitive and language functions, including naming, which is often impaired in people with aphasia. The PI's prior work shows that cerebellar tDCS is safe, easily tolerated, and improved language skills in a number of stroke participants with aphasia. The proposed project will build on these findings by conducting a randomized, double-blind, sham-controlled, trial to determine the effectiveness of cathodal tDCS to the right cerebellum for the treatment of post-stroke aphasia. We will compare the effects of 15 sessions of cerebellar tDCS combined with an evidenced-based anomia treatment (semantic feature analysis, SFA) to 15 sessions of sham combined with SFA treatment in patients with chronic (at least 6 months post stroke) aphasia. We will evaluate the effects of cerebellar tDCS on naming untrained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. This project will also identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. Individual response to tDCS treatment is highly variable, and little is known about how factors related to imaging and linguistic characteristics combine to induce treatment responsiveness. We will carry out resting state functional magnetic resonance imaging (rsfMRI), diffusion tensor imaging (DTI), high resolution structural imaging, and detailed linguistic testing before the start of treatment to determine whether these factors can predict response to cerebellar tDCS and/or SFA. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent SLT for treatment of chronic aphasia.