Language improvements after TMS plus modified CILT: Pilot, open-protocol study with two, chronic nonfluent aphasia cases

Abstract

Purpose: The purpose of this study was to investigate: 1) the feasibilty of administering a modified CILT (mCILT) treatment session immediately after TMS; and 2) if this combined therapy could improve naming and elicited propositional speech in chronic, nonfluent aphasia. Methods: Two chronic stroke patients with nonfluent aphasia (mild-moderate and severe) each received twenty minutes of rTMS to suppress the right pars triangularis, followed immediately by three hours of mCILT (5 days/week, 2 weeks). (Each patient had received TMS alone, 2–6 years prior.) Language evaluations were performed pre- TMS+mCILT, and post- at 1-2 months, and 6 or 16 months. Results: Both patients showed significant improvements in naming pictures, and elicited propositional speech at 1-2 months post- TMS+mCILT. The improved naming was still present at 6 months post- TMS+mCILT for P2; but not at 16 months post- TMS+mCILT for P1. Conclusions: It is feasible to administer mCILT for three hours immediately after a TMS session. It is unknown if the significant improvements in naming pictures, and elicited propositional speech were associated with the second series of TMS, or this first series of mCILT, or a combination of both. A larger, sham controlled clinical trial is warranted.

A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: Leads for future studies

“…However, 27 studies combined magnetic stimulation with SLT, generally to activate the LH and improve naming, repetition, writing, and the expression and comprehension of spoken language. Some studies involved particular rehabilitation protocols such as melodic intonation therapy (Al-Janabi et al, 2014), intensive language-action therapy (Heikkinen et al, 2019), or constraint-induced language/aphasia therapy (Martin et al, 2014;Naeser et al, 2012;Naeser et al, 2010;Szaflarski et al, 2018). No study has yet compared the difference between benefits of rTMS with or without SLT.…”

The Role of Gesture in Communication and Cognition: Implications for Understanding and Treating Neurogenic Communication Disorders

“…Indeed, these studies are highly variable in the extent to which they constrain gesture and often not well described ( Pierce et al, 2017 ). Some studies prohibited gesture use ( Pulvermüller et al, 2001 ) and even strictly enforced spoken language by asking patients to sit on their hands if necessary ( Maher et al, 2006 ; Kirmess and Maher, 2010 ; Martin et al, 2014 ). Others allowed gesture use as long as it was used to facilitate verbal language output (i.e., for self-cueing; Meinzer et al, 2007a , b ; Difrancesco et al, 2012 ; Wilssens et al, 2015 ; Ciccone et al, 2016 ; Nickels and Osborne, 2016 ).…”

Assessment of Subjective Tinnitus Treatment Results Using a Prototype Device for Electrical and Magnetic Stimulation of the Ear-Preliminary Study

“…Transcranial magnetic stimulation (TMS) has been used in medicine for several decades. It is a non-invasive method affecting the excitability of the cerebral cortex, owing to which it has gained increasing attention as a therapeutic tool in a wide spectrum of neuropsychiatric disorders [ 19 , 20 , 21 , 22 , 23 ]. Low-frequency repetitive transcranial magnetic stimulation (rTMS), e.g., 1 Hz, effectively reduces cortical activity, especially in the areas of increased excitability.…”