Cerebellar stimulation for Aphasia Rehabilitation

项目摘要 失语症是中风的一种毁灭性并发症。言语和语言治疗(SLT)有助于恢复 语言功能，但并不是所有的个体都有进步。最近的研究表明，经颅直达 电流刺激是提高SLT疗效的一种很有前景的辅助治疗方法。Tdcs是一个 对大脑的非侵入性、非痛性的电刺激。据认为，tdcs增强了神经的可塑性， SLT为复苏奠定了基础。大多数失语症的tdcs研究都刺激了左半球。 地区。然而，中风后失语症中常见的左半球损害会影响大脑中的电场。 不可预测的方式，潜在地阻止刺激到达与最佳 恢复。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。右翼 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之前的工作表明，小脑TDCs 是安全的，易于耐受，并改善了一些中风失语症患者的语言技能。这个 拟议的项目将以这些发现为基础，进行随机、双盲、假对照试验，以 确定右侧小脑阴极TDC治疗卒中后失语的疗效。 我们将比较15次小脑tdcs结合循证异常的效果。 治疗(语义特征分析，SFA)至15个疗程的SHAM联合SFA治疗 慢性(中风后至少6个月)失语症。我们将评估小脑TDCs对命名的影响 以及对功能沟通、内容、效率和词汇提取的影响 图片描述，生活质量。该项目还将确定成像和语言生物标记物，以确定 卒中患者受益于小脑TDC和SFA治疗的特点。个人反应 对于tdcs的治疗是高度可变的，关于成像和语言因素是如何相关的知之甚少。 这些特征结合在一起可以诱导治疗反应性。我们将进行静息状态的功能磁化 磁共振成像(RsfMRI)、扩散张量成像(DTI)、高分辨率结构成像和详细 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。这项研究的长期目标是为第三阶段随机试验提供基础 小脑TDCs与SHAM合并SLT治疗慢性失语的对照试验。

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.