The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis

Abstract

Background: Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. Methods: Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. Results: Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. Conclusion: The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.

Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review

“…[ 7 , 8 , 9 ]. Several meta-analyses have indicated the positive effects of NIBS on functional recovery in stroke patients [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Orrù et al and Li et al found NIBS to be effective in improving upper extremity motor function and activities of daily life after stroke, with the most significant intervention effect observed with anodal-tDCS [ 10 , 11 ].…”

“…Additionally, Chen et al’s review highlighted that stimulation of the primary motor cortex and/or primary somatosensory cortex significantly enhanced post-stroke sensory dysfunction [ 13 ]. And, evidence from other meta-analyses has also demonstrated the beneficial effects of NIBS in stroke patients with aphasia [ 14 ], cognitive impairment [ 15 ], and emotional disorders such as depression [ 16 ].…”

“…As of now, the primary targets of NIBS continue to focus on supratentorial regions, such as the primary motor cortex (M1) for enhancing motor function and the Broca area for speech improvement [ 14 , 17 ]. However, some studies have not yielded satisfactory results [ 17 ].…”