Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

Abstract

Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

“…There are many problems with conducting RCTs that are currently considered as major standards for unbiased research. However, the PWA groups are heterogeneous and post-stroke aphasia is characterized by an unstable status, with rapid changes, and often significant improvement in the very early phase (<2 weeks after stroke) [4,7]. Therefore, it is difficult to form adequate subgroups and estimate the impact of therapy on patient improvement.…”

“…Treatment of post-stroke patients with aphasia is based on strictly defined principles [7]. Different therapy objectives are distinguished, depending on the time of the infarction.…”

“…The aim of rehabilitating patients with aphasia is to enable communication with the environment, compensate behavioral deficits manifested by changing the programs of a given activity, and improve the effectiveness of patient behavior (i.e., by modifying their environments, see Figure 1). The rehabilitation program should be determined, primarily, by a number of factors, including the severity and type of aphasia, etiology, other cognitive-behavioral dysfunctions accompanying aphasia, and stage of recovery [7]. The most commonly used clinical terminology to describe the recovery phases after a stroke are: acute (stroke unit), subacute (neurorehabilitation unit-active rehabilitation), and chronic (compensation rather than functional restoration).…”

DUAL-tDCS Treatment over the Temporo-Parietal Cortex Enhances Writing Skills: First Evidence from Chronic Post-Stroke Aphasia

“…Indeed, although several studies have shown that the chronically reorganized language system can sometimes engage homotopic language areas in the right hemisphere [39][40][41], particularly in the case of an extended lesion to the left hemisphere [40,42,43], an abnormal interhemispheric imbalance due to an increase in the excitability of the undamaged right hemisphere which exerts interhemispheric inhibition (IHI) over the lesioned one has also been often described after unilateral left-hemispheric stroke. Thus, in order to restore this maladaptive condition, dual-tDCS has also been proposed (see for a review [31,44]). To our knowledge, to date, only a single case with post-stroke aphasia has been reported in which the use of dual tDCS resulted in successful improvement of written language [45].…”

Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia

“…A key issue in aphasia rehabilitation is the need to implement traditional language treatments with new approaches that are effective and safe. The review by Picano et al, “Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety” [ 8 ], examines the approaches most commonly used in recent years (pharmacology, virtual reality, and transcranial direct current stimulation) in the field of aphasia, which go beyond the classical view of language representation. Indeed, all of these approaches rely on the hypothesis that the language system is not modularized into specific language areas but is considered as a widely distributed network across the brain.…”