Combining Language Therapy With rTMS in Aphasia (ILAT+rTMS)

Paula Heikkinen

Status: Completed

Conditions: Aphasia

Treatments: Behavioral: Intensive Language-Action Therapy (ILAT); Device: Repetitive navigated Transcranial Magnetic Stimulation during naming training

Study type: Interventional

Funder types: Other

Identifiers

NCT03629665

HelsinkiUniversity/Logopedics

Details and patient eligibility

About

With the present RCT, the investigators aimed at finding an optimal protocol for the neurorehabilitation of chronic post-stroke aphasia by combining two promising methods, ILAT (Intensive language action therapy) and 1-Hz rTMS to the right-hemispheric homologue of the anterior language area of Broca (pars triangularis), thus taking advantage of recent research in speech and language sciences, neurorehabilitation and brain research.

Full description

New neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included. Combined with behavioral techniques, Intensive Language-Action Therapy (ILAT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone.

In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage will be studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex (pars triangularis). Participant will be randomized to groups A and B. Participants in group A will receive a 2-week period of rTMS during naming training where they name pictures every ten second displayed on the screen, followed by 2-weeks of rTMS and naming combined with ILAT. Those in group B will receive the same behavioral therapy but TMS is replaced by sham stimulation.

Language performance will be measured before, during and after the interventions for 3 months.

Enrollment: 17 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• age between 18 and 75 years
• presence of a single clinically documented stroke
• chronic stage (at least 12 months post-stroke)
• aphasia documented using the WAB test
• no recurring utterances or severe global (total) aphasia
• residual ability to understand simple task instructions
• availability of information about medication
• right-handedness
• native speakers of Finnish.

Exclusion criteria

• severe global (total) aphasia (Boston naming test less 3 points)
• neglect, agnosia, severe vision impairment or hearing loss
• severe attention or memory deficits
• left-handedness
• cardiac pacemaker or other stimulators
• diagnosis of severe diabetes or severe depression
• additional neurological diagnoses
• other interventions, including speech therapy, in the same time period

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Triple Blind

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17 participants in 2 patient groups

rTMS and naming combined with ILAT

Active Comparator group

Description:

Interventions: Repetitive navigated Transcranial Magnetic Stimulation, picture naming and Intensive Language Action Therapy

Treatment:

Device: Repetitive navigated Transcranial Magnetic Stimulation during naming training

Behavioral: Intensive Language-Action Therapy (ILAT)

sham rTMS and naming combined with ILAT

Sham Comparator group

Description:

Interventions: sham Repetitive navigated Transcranial Magnetic Stimulation, picture naming and Intensive Language Action Therapy

Treatment:

Behavioral: Intensive Language-Action Therapy (ILAT)