Effects of a Combination of Transcranial Direct Stimulation (tDCS) and Behavioral Intervention in Non-fluent Aphasia
Phase: NA
Conditions: Aphasia
Sponsor: University of Minnesota

1 
 
Scientific Review: Method 3 
1 
Study Title: Use of anodal transcranial direct current stimulation (a-tDCS) to DLPFC to 
2 
influence naming in patients with non-fluent aphasia: a feasibility and safety study. 
3 
 
4 
Reviewer 1  
5 
Name:  Bernadette Gillick, PhD, MSPT, PT Affiliation: University of Minnesota Program in PT 
6 
 
7 
Review 2  
8 
Name: James Carey, PhD, PT 
 
Affiliation: University of Minnesota Program in PT 
9 
 
10 
 
11 
 
12 
Reviewer 3 (optional) 
13 
Name:  
 
 
 
 
Affiliation: 
14 
 
15 
Date of Review: 11.3.14 (Final) 
 
Method of Review: Collaborative via email 
16 
Discussion: At this time of 3 rd review, the proposal is deemed satisfactory in its 
17 
science.   
18 
 
19 
Decision: Approved. 
20 
 
21 
Signatures:  
22 
_____________
_______________11.4.14_______________________ 
23 
Reviewer 1 
 
 
 
 
 
 
Date 
24 
 
25 
__________
_______________11/4/14_________________________ 
26 
Reviewer 2 
 
 
 
 
 
 
Date 
27 
 
28 
_________________________________________________________ 
29 
Reviewer 3 (optional) 
 
 
 
 
Date 
30 
 
 
31 

2 
 
Scientific Assessment: Method 3 
1 
Study Title: Effects of anodal transcranial direct current stimulation (a-tDCS) on naming in 
2 
patients with non-fluent aphasia. 
3 
PI: Sharyl Samargia, PhD CCC-SLP 
4 
Co-investigator: Naomi Hashimoto, PhD CCC-SLP 
5 
 
Is the rationale for the study clearly stated and is the rationale scientifically 
6 
sound?  
7 
 
8 
The emerging evidence of the relationship between working memory (WM) and naming 
9 
offers a unique opportunity to investigate the effects of upregulation of WM systems and the 
10 
effect on naming in nonfluent aphasia. Transcranial direct current stimulation (tDCS) is a 
11 
non-invasive neuromodulation tool that presents a low current that induces bi-directional 
12 
polarity-dependent changes in the cortex to facilitate focal, prolonged shifts in cortical 
13 
excitability at or around the time stimulation is provided 1, 2. Anodal tDCS (a-tDCS), in which 
14 
the positively charged electrode is placed over the targeted cortical region, has been shown 
15 
to increase cortical excitability (upregulation), similar to long-term potentiation (LTP)1-5. 
16 
Combining a-tDCS with behavioral-based approaches has been suggested to enhance the 
17 
learning process and increase the likelihood of retention6.  Although there is no specific 
18 
neurophysiologic evidence to identify suppression of dorsolateral prefrontal cortex (DLPFC) 
19 
in participants with aphasia, it has been implicated in naming deficits due to its role in 
20 
working memory. tDCS has been applied to the DLPFC to target working memory7-10, to 
21 
date, there have been no investigations using a-tDCS to the DLPFC to influence naming 
22 
skills in non-fluent aphasia. The overarching goal of this study is to explore the relationship 
23 
between WM and naming by investigating the effects of a-tDCS to left DLPFC on naming 
24 
accuracy and naming reaction times (RTs) in non-fluent aphasia. The primary purpose of this 
25 
study is to 1) establish feasibility and safety of applying a-tDCS to the left DLPFC in patients 
26 
with Broca’s aphasia combined with behavioral naming treatment.  
27 
 
Are the aims and corresponding hypothesis clearly stated? 
28 
 
29 
Aim 1: Determine feasibility and safety of applying a-tDCS to the left DLPFC in Broca’s aphasia. 
30 
Two conditions: 1)a-tDCS (2mA for 20 minutes) will be applied over the left DLPFC followed 
31 
immediately by behavioral naming therapy and 2) sham tDCS followed immediately by 
32 
behavioral naming therapy will be presented to participants with non-fluent aphasia.  Hypothesis 
33 
1: no adverse events will be reported during or following this treatment and all participants will 
34 
complete the study.   
35 
 
36 
Aim 2: Identify effectiveness of a-tDCS to the left DLPFC combined with behavioral naming 
37 
treatment in Broca’s aphasia and establish a sample size for future investigations of this nature. 
38 
A small sample size will be used in this study to investigate effectiveness of the use of a-tDCS 
39 
to the left DLPFC with behavioral therapy to target naming in non-fluent aphasia. Hypothesis 2: 
40 
Improvements in working memory, naming reaction time and naming accuracy will be observed 
41 
after the real a-tDCS condition but not after the sham a-tDCS condition.  
42 
 
43 
 
44 

3 
 
 
Is the primary outcome (and secondary outcomes, as appropriate) clearly 
1 
defined? 
2 
Primary outcomes include: naming accuracy on treated and control items, naming RTs on 
3 
treated and control items, performance on WM tasks, and motor speech tasks.    
4 
 
Are there adequate preliminary data in the literature (or from the investigator) to 
5 
justify the proposed research? Has an adequate literature review been done to 
6 
support this study? 
7 
 
8 
WM systems are short-term, temporary stores that are activated when active manipulation of 
9 
items is necessary20.   It could be argued that all linguistic tasks invoke WM systems since the 
10 
execution of any linguistic task requires the ability to maintain activation of a representation until 
11 
the targeted linguistic process is complete.  Indeed, the close relationship between language 
12 
and WM is represented in many WM models11-13.  Over the past few decades, there has been 
13 
increasing recognition that aphasia is frequently accompanied by deficits in WM systems.  
14 
Furthermore, such deficits adversely impact linguistic performance in aphasia.  Accordingly, 
15 
treatment protocols are being developed on the premise that treatments aimed at improving WM 
16 
systems will improve linguistic function in aphasia14, 15.  While a variety of WM treatment 
17 
protocols have been designed to improve linguistic processes such as oral reading, repetition, 
18 
or comprehension abilities in aphasia, there are no such studies in the area of naming.  Yet, one 
19 
particular WM component, subvocal rehearsal processes11, 16, may play a crucial role in naming 
20 
abilities in aphasia.  Subvocal rehearsal processes are activated when verbal memory traces 
21 
must be refreshed.  Such processes become vital in cue-based protocols17-21 where the 
22 
individual is asked to self-generate cues needed to increase lexical access to the object name. 
23 
Within this context, it may be that subvocal rehearsal systems might be crucial during picture 
24 
naming processes as it functions to preserve and refresh information, facilitating convergence of 
25 
activation onto targeted representations. This becomes a useful compensatory strategy when 
26 
there are lexical access and retrieval failures. However, the ability to engage in subvocal 
27 
rehearsal processes are likely deficient in individuals with aphasia14 15, which impacts not only 
28 
immediate treatment effects, but also long-term treatment effects since cue self-generation as a 
29 
compensatory strategy would be limited.   
30 
The application of a-tDCS to the language regions in combination with behavioral-based 
31 
approaches has resulted in improved language outcomes in individuals with aphasia 22-26. In 
32 
addition, a-tDCS applied to the left DLPFC has resulted in improved performance on WM tasks 
33 
in healthy individuals 27, individuals with Parkinson’s Disease 7 and stroke 28. a-tDCS is ideally 
34 
suited to upregulate the left DLPFC and may potentially activate subvocal rehearsal processes 
35 
needed in order to improve self-generation of cues during naming. However, there have been 
36 
no investigations to date using neuromodulation techniques to the DLPFC to target naming 
37 
skills in aphasia.  
38 
 
39 
 
Is the question or hypothesis being tested providing important knowledge to the 
40 
field? 
41 
 
42 
The findings from the proposed study will lay the foundation for a larger clinical trial which will 
43 
in turn have a significant impact on individuals with aphasia given that naming deficits are a 
44 
common symptom in this population. As the presence of naming deficits has a negative 
45 
relationship to emotional well-being and functional communication 29-33, treatment that 
46 
improves naming deficits will positively influence quality of life in many of these individuals.  
47 
The approach taken to remediate naming deficits in aphasia is to treat impaired WM systems 
48 

4 
 
on the premise that certain cognitive processes underlie linguistic functions in aphasia.  This 
1 
approach represents a departure from most behavioral-based naming treatment approaches, 
2 
but reflects a growing recognition that WM systems in individuals with aphasia impact 
3 
linguistic performance 14, 34.  The addition of a-tDCS as a neuromodulation tool to increase 
4 
cortical excitability (upregulate) the working memory center to target naming is a novel 
5 
approach in aphasia.  These findings, , will provide valuable information regarding the role 
6 
WM plays in naming and the potential benefit of using neuromodulation to the DLPFC to 
7 
influence naming in aphasia.   
8 
 
9 
 
Is the design of the study appropriate for the questions that are posed? 
10 
 
11 
Treatment Design:   
12 
A single subject cross-over design with a 4 week wash out period will be used. Two treatment 
13 
conditions will be presented.  The sham (SHAM) condition will consist of presentation of sham 
14 
tDCS for 20 minutes followed by behavioral naming treatment. The real treatment condition 
15 
(REAL) will consist of 20 minutes of a-tDCS to the left DLPFC followed by behavioral naming 
16 
treatment. The length of behavioral naming treatment will depend on how long each participant 
17 
takes to go through the treatment stimuli twice. A SHAM-REAL sequence will be used across all 
18 
participants. Although order effects may be introduced using the same sequence across 
19 
participants, the small number of participants makes it difficult to interpret any data that comes 
20 
from using a counterbalanced presentation of treatment.   
21 
Treatment will be provided over five consecutive days. A minimum of a one-month washout 
22 
period will be provided between the two conditions (Figure 1).  Prior to initiating the REAL 
23 
treatment condition, the naming RTs obtained on the second word list during the pre-treatment 
24 
testing period (prior to the initiation of the SHAM condition) will be compared to the naming RTs 
25 
obtained after the washout period.  RTs will be analyzed to ensure that no lasting treatment 
26 
effects remain after the SHAM condition.  If performance on naming RTs is +/- 1 standard 
27 
deviation from the individual’s benchmark mean, the REAL treatment condition will begin. If 
28 
performance on naming RTs is > +/- 1 standard deviation from the individual’s benchmark 
29 
mean, REAL treatment will be postponed until the mean RTs fall within +/- 1 standard deviation 
30 
of the benchmark. Periodic checks will be conducted weekly to identify when to begin REAL 
31 
condition.  Once there are minimal differences between naming RTs on the second word list, 
32 
the REAL treatment will be initiated.   
33 
 
34 
Outcome measures:   
35 
Two different word lists will be generated;  a different list will be used for each treatment 
36 
condition to control for exposure and learning effect.Pretreatment testing outcome measures will 
37 
be recorded for 5 consecutive days for each outcome measure including: 1) naming accuracy 2) 
38 
naming RTs on both word lists 3) performance on motor speech tasks and 4) performance on 
39 
working memory tasks. Stability of baseline performance, defined as no more than 20% 
40 
difference between scores, will be obtained in five consecutive sessions.  In addition, outcome 
41 
measures will be obtained immediately after each treatment session. Five maintenance 
42 
outcome measures will also be obtained upon completion of treatment. These sessions will take 
43 
place at the Clinical Translational Science Institute (CTSI) on Delaware Street on the University 
44 
of MN campus. An adverse events questionnarie will also be given after each treatment session 
45 
as a mechanism of participants reporting any discomfort.   
46 
 
47 
  
48 
 
49 
 
50 

5 
 
Figure 1. Treatment Schedule  
1 
 
2 
 
3 
 
4 
 
5 
tDCS Protocol.   
6 
Treatment sessions will take place at the University of MN Clinical Translational Science 
7 
Institute.   Each participant will be seated comfortably in a chair. A swim cap will be placed on 
8 
the participant’s head to identify cranial landmarks for accurate electrode placement. The area 
9 
referred to as F3 by the International 10/20 system for electroencephalogram electrode 
10 
placement35 has been established as the optimal location for targeting the left DLPFC8, 9, 28, 36. 
11 
The F3 region will be located by marking the vertex (the midpoint between left and right tragus 
12 
and midpoint between nasion and inion), measuring the head circumference. When these 
13 
measurements are entered into the Beam F3 Locator Software37, additional values are provided 
14 
to reliably identify the location of F3. Once F3 has been established, two saline soaked surface 
15 
sponge electrodes (352cm) will be prepared and placed. For optimal anodal stimulation to the 
16 
DLPFC, the anode will be placed over F3 and the cathode will be placed over the right 
17 
supraorbital region7-9, 27. A current of 2mA will be delivered for 20 minutes 7 by a multichannel 
18 
transcranial current stimulator (Starstim, Neuroelectrics Corporation; Cambridge, MA). a-tDCS 
19 
will be applied before and during behavioral treatment in the design specified below.  
20 
 
21 
 
22 
 
23 
 
24 
Behavioral-Based Naming Treatment Protocol.   
25 
 
26 
Stimuli. Eighty black-and-white line drawings will be obtained from on-line clip art websites.  
27 
Picture names will be normed using five to ten English-speaking volunteers who will be asked to 
28 
provide the names of the pictures.  Cues words will be paired with the pictures if the words 
29 
represent an associative or thematic relationship.  Therefore, the words will be chosen that 
30 
represent a concrete attribute (e.g., the picture, SHARK, is paired with the cue word teeth), 
31 
location (e.g., the picture, SHARK, is paired with the cue word ocean), and either function or 
32 
category (e.g., the picture, SHARK, is paired with the cue word, fish).  The selection criteria for 
33 
choosing these particular attributes is based on a classification criteria of thematic relations 38.  
34 
Moreover, there is empirical evidence that that associative relations would prove beneficial in a 
35 
naming treatment paradigm 39.  Commonly used phrases (e.g., great white shark) or compound 
36 
words (e.g., bluefin shark), synonyms or antonyms will be excluded.  These cue words will be 
37 
obtained from a semantic features normative database 40, which provides not only semantic 
38 
Pretreatment
Testing
5consecutive
days
SHAM Treatment
Sham tDCS + naming
5 consecutive days
PROBE outcomes 
each day following 
treatment
Post-treatment 
Testing 
5 consecutive 
days
Washout Period
4 weeks
Pretreatment
Testing
5consecutive
days
REAL Treatment
a-tDCS + naming
5 consecutive days
PROBE outcomes each 
day following 
treatment
Post-treatment 
Testing
5 consecutive 
days
Follow up
4 weeks

6 
 
features information but categorical information as well.   Two lists of 20-items will be created, 
1 
which will be presented to each participant in order to avoid presenting the same list across the 
2 
conditions.  Pictures used in both lists will be balanced in terms of visual complexity and 
3 
familiarity ratings.  Words used in all conditions will be balanced in terms of lexical frequency 
4 
and word length.  Familiarity ratings will be obtained from a normative database40.  Visual 
5 
complexity ratings will be also obtained from a group of 20 individuals using the instructions and 
6 
rating scales as reported in Snodgrass and Vanderwart’s41 article.  The CELEX database 42, will 
7 
be consulted to determine lexical frequency of the words (cues) used in the study.  An additional 
8 
40 pictures will be selected for a control (untreated) list that will be used only during baseline 
9 
and post-treatment testing.  Performance on treated and untreated lists will be compared to 
10 
determine treatment effects and possible generalization effects.   
11 
 
12 
Naming Treatment Procedures.  All participants will be provided the same protocol, which will 
13 
highlight the process of rehearsing the cues associated with the picture name.  Treatment 
14 
sessions will last until each participant has gone through the treated items twice.  To insure 
15 
control during the protocol, a graduate student trained in the protocol will administer the 
16 
treatment steps.  She will be blinded to the objectives of the study and conditions that are being 
17 
administered. Treatment sessions will be video recorded for reliability purposes. To insure that 
18 
she is not aware of when tDCS is being administered, a screen will be in place between the 
19 
tDCS machine and the treatment table.  The protocol is provided in Table 1.   
20 
 
21 
Table 1.  Naming Treatment Protocol. 
22 
Steps Involved in Naming Treatment Protocol 
Picture Presentation 
Participant will be asked to name the picture.  If she/he is 
unable to provide the name within 10 seconds, the name 
will be provided.   
Cue Presentation 
Cues that accompany the picture will be presented. He/she 
will be asked to read each cue word as it is presented.  If 
he/she is unable to read the word spontaneously within 10 
seconds, he/she will be asked to repeat each word after the 
clinician. 
Cue Rehearsal 
Both picture and cues are taken away.  Participant is asked 
to rehearse the cue words silently for 10 seconds. 
Cue Self-Generation 
Participant will be asked to generate all three cues.  For 
each instance that the participant is unable to provide a cue 
within 10 seconds, the cues will be provided.  Once the 
cues have been provided, the participant will then be asked 
to provide the picture name. 
Picture + Cue Presentation 
If the participant is unable to provide the name, the cues 
will be read, or if he/she is unable to read spontaneously, 
he/she will be asked to repeat after the clinician.  If she/he 
is still unable to provide the picture name after the cue 
review, it will be provided. 
Picture + Cue Review 
Once the cues and picture are laid out on the table, the 
clinician will read each cue and name the picture. The 
participant will be encouraged to read/repeat with the 
clinician.   

7 
 
 
1 
 
Have the validity and reliability of measures been established or are there 
2 
methods proposed for establishing validity and reliability? 
3 
 
4 
Approximately 20% of each of the participant’s behavioral treatment sessions will be 
5 
observed by the co-investigator in order to obtain procedural integrity.  Steps of the treatment 
6 
protocol will be scored using a binary (+/-) coding system.  Point-by-point agreement will be 
7 
obtained.  Reliability in scoring naming error types will also be obtained using a table that 
8 
lists the most common aphasic naming errors, definitions and examples of each error type.  
9 
Point-by-point agreement will be obtained. 
10 
 
11 
 
Is the proposed subject population appropriate? 
12 
Participants will be recruited via emails sent to Twin Cities metro area hospital and 
13 
aphasia/stroke support groups.  Potential participants will then be screened for eligibility for 
14 
the study. 
15 
Screening. Potential participants will be seen for 2-3 sessions to undergo comprehensive 
16 
cognitive-linguistic assessment to determine eligibility for the study. This assessment will 
17 
take place within the participant’s home to provide a comfortable, natural environment for the 
18 
potential participant.  Behavioral assessment measures will include the Western Aphasia 
19 
Battery (WAB) 43 which will be used to obtain overall language function via the WAB Aphasia 
20 
Quotient (WAB AQ), the Boston Naming Test (BNT) in order to obtain naming function, 44, 
21 
Apraxia Battery for Adults (ABA-2) 45 in order to determine apraxia of speech severity,  and 
22 
working memory tasks to determine subvocal rehearsal processes and phonological short-
23 
term store abilities. 
24 
These participants must meet the following inclusionary criteria: 
25 
 
a diagnosis of moderate-moderately severe non-fluent aphasia based on 
26 
performance on the WAB  (see above screening procedures). 
27 
 
a diagnosis of moderate-moderately severe non-fluent aphasia based on 
28 
performance on the BNT (see above screening procedures). 
29 
 
a diagnosis of mild-moderate apraxia of speech (AoS) based on performance on the 
30 
ABA-2 (see above screening procedures). 
31 
 
completion of high school or GED 
32 
 
normal or corrected-to-normal vision 
33 
 
adequate hearing acuity for 1:1 conversational exchanges 
34 
 
use of English as primary language 
35 
 
a vascular lesion in the dominant left hemisphere, not in the region of the DLPFC 
36 
verified by an MRI scan within six months of the start of the study.  
37 
These participants must also meet the following exclusionary criteria: 
38 
 
39 
 
no previous history of neurological- or psychiatric-based illnesses or disease, 
40 
language or learning disabilities, or alcohol/substance abuse 
41 
 
no history of seizures 
42 
 
no metal implants in the head (except dental fillings) 
43 
 
no lesion in the left DLPFC confirmed by MRI 
44 

8 
 
 
no current pregnancy 
1 
 
2 
Individuals who meet the inclusionary/exclusionary criteria and who are still interested in 
3 
participating will then be consented to participate in the research study. After four 
4 
participants have been identified as eligible and consented for the study, recruitment will 
5 
stop. 
6 
 
Are statistical considerations, including sample size and justification, estimated 
7 
accrual and duration, and statistical analysis clearly described and adequate to 
8 
meet the study objectives? 
9 
 
10 
Descriptive statistics such as naming percent accuracy, range of naming percent accuracy, 
11 
number of cues generated independently, and rates of naming errors, will be collected. Although 
12 
normally distributed data is not expected in this small sample size and in this population of 
13 
participants, a Shapiro-Wilk test of normal distribution will be conducted to report the 
14 
distribution. Single subject analysis techniques will be used such as visual inspection, graphical 
15 
analysis and confidence interval comparison.  
16 
 
17 
Aim 1. To address the feasibility and safety aim, the number and type of adverse events for 
18 
each patient will be recorded and presented. In addition, the number of participants who failed 
19 
to complete the study will be recorded and factors recorded. To the extent possible, the 
20 
participants will be asked to continue to participate in the assessments to allow a consideration 
21 
of intent to treat analysis.   
22 
 
23 
Aim 2. Means and 95% confidence intervals will be plotted and used for comparison of naming 
24 
RTs, working memory performance and motor speech performance across treatment conditions 
25 
for each subject (Deng, et al. 2013).  Naming accuracy performance will be analyzed using d 
26 
statistics for lexical data to determine magnitude of treatment effect 46, 47. The effect size will be 
27 
interpreted using benchmarks proposed by Beeson and Robey (2006) for lexical retrieval 
28 
treatments:  small ES = 4.0, medium ES = 7.0, large ES = 10.146.  Naming RT mean and 
29 
confidence intervals will be analyzed for changes within and across treatment conditions using 
30 
visual inspection.  
31 
 
32 
 
Are all the proposed tests or measurements requested necessary to answer the 
33 
scientific question?  
34 
Yes.  The proposed measures will allow investigators to report the feasibility and safety of 
35 
the use of a-tDCS The measures will also allow investigators to identify individual treatment 
36 
effects of a-tDCS to left DPFC combined with behavioral naming therapy on naming in non-
37 
fluent aphasia and through visual inspection and graphical analysis, compare effects to sham 
38 
treatment. Naming RT and accuracy are sensitive measures of the participant’s retrieval and 
39 
learning of treated items. Motor speech performance will allow us to track changes in motor 
40 
planning and sequencing abilities, which can influence naming RT and naming accuracy. 
41 
And, performance on working memory tasks will allow for investigation of the influence of 
42 
WM on naming and to provide additional evidence that a-tDCS to the left DLPFC may 
43 
influence WM in individual participants.  
44 
 
45 
 
Are the investigators well qualified to conduct this study?  
46 
 
47 
Key Personnel 
48 

9 
 
 
1 
Name  
 
 
 
Affiliation 
 
 
 
Role 
 
 
2 
Sharyl Samargia, PhD CCC-SLP 
University Wisconsin River Falls  
PI 
3 
 
4 
Dr. Samargia is associate professor in the Department of Communication Sciences and 
5 
Disorders and will serve as the principal investigator for the project. Dr. Samargia has expertise 
6 
in neurophysiologic mechanisms and neuromodulation in healthy and neurologic populations. 
7 
She will provide rationale and guidance in the neurophysiologic mechanisms of tDCS and will 
8 
administer tDCS to the subjects.   
9 
 
10 
Name  
 
 
 
Affiliation 
 
 
 
Role 
11 
Naomi Hashimoto, PhD CCC-SLP 
University of Wisconsin-River Falls Co-investigator 
12 
 
13 
Dr. Hashimoto is an associate professor in the Department of Communicative Sciences and 
14 
Disorders. Dr. Hashimoto’s research interest involves the examination of lexical-semantic 
15 
deficits in individuals with aphasia. The deficits found in these individuals are interpreted within 
16 
the context of a cognitive neuropsychology approach. Methodologies such as on-line measures 
17 
and the more traditional assessment batteries are used to examine how various aspects of the 
18 
lexical-semantic (word meaning) system operates in the brains of neurologically intact 
19 
individuals and individuals with aphasia.  She is the director of the Aphasia Research 
20 
Laboratory at UWRF. 
21 
 
22 
Name  
 
 
 
Affiliation 
 
 
 
Role 
23 
Teresa Jacobson Kimberley, PhD PTUniversity Minnesota Twin Cities 
Mentor 
24 
 
25 
Dr. Kimberley is an associate professor in the Programs in Physical Therapy and Rehabilitation 
26 
Science and serves as a director of the Brain Plasticity Lab. Dr. Kimberley has expertise in 
27 
neurophysiologic mechanisms and neuromodulation (including tDCS) in healthy individuals and 
28 
a number of patient populations including stroke and will serve as a mentor for the project, 
29 
providing tDCS training and will assist in reviewing MRI scans. 
30 
 
 
31 

10 
 
 
1 
Name  
 
 
Affiliation 
 
 
 
Role 
2 
Mo Chen, PhD 
 
University Minnesota Twin Cities 
Consultant 
3 
 
4 
Dr. Chen is a postdoctoral associate in the Program in Physical Therapy and Rehabilitation 
5 
Science. As a biomedical engineer, he is able to provide custom equipment modifications and 
6 
programming.  
7 
 
8 
Name  
 
 
Affiliation 
 
 
 
Role 
9 
TBA 
 
 
 
University of Wisconsin-River Falls Research Assistant 
10 
 
11 
A first year graduate student from the Department of Communicative Disorders will be selected 
12 
as a research assistant based on GPA, clinical performance and experience with patients with 
13 
aphasia. The research assistant will provide behavioral naming therapy (naïve to the treatment 
14 
conditions) to the subjects under the supervision of the PI to avoid clinician bias in judging 
15 
subject responses.  
16 
 
17 
References 
18 
1. 
Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak 
19 
transcranial direct current stimulation. Journal of Physiology 2000;527(3):633-639. 
20 
2. 
Priori A, Berardelli A, Rona S, Accornero N, Manfredi M. Polarization of the human motor cortex 
21 
through the scalp. . Neuroreport 1998;9(10):2257-2260. 
22 
3. 
Nitsche MA, Cohen LG, Wassermann EM, et al. Transcranial direct current stimulation: state of 
23 
the art 2008. Brain Stimulation 2008;1:206-223. 
24 
4. 
Jacobson L, Koslowsky M, Lavidor M. tDCS polarity effects in motor and cognitive domains: a 
25 
meta-analytical review. Exp Brain Res 2012;216:1-10. 
26 
5. 
Ardolino G, Bossi B, Barbieri S, Priori A. Non-synaptic mechanisms underlie the after-effects of 
27 
cathodal transcutaneous direct current stimulation of the human brain. . J Physiol 2005;568 (Pt 2):653-
28 
663. 
29 
6. 
Floel A. tDCS-enhanced motor and cognitive function in neurological diseases. NeuroImage 
30 
2014;85:934-947. 
31 
7. 
Boggio PS, Ferrucci R, Rigonatti SP, et al. Effects of transcranial direct current stimulation on 
32 
working memory in patients with Parkinson's disease. Journal of the Neurological Sciences 2006;249:31-
33 
38. 
34 
8. 
Fregni F, Boggio PS, Nitsche MA, et al. Anodal transcranial direct current stimulation of 
35 
prefrontal cortex enhances working memory. Exp Brain Res 2005;166:23-30. 
36 
9. 
Ohn SH, Park C, Yoo WK, et al. Time-dependent effect of transcranial direct current stimulation 
37 
on the enhancement of working memory. Neuroreport 2008;19(1):43-47. 
38 
10. 
Zaehle T, Sandmann P, Thorne JD, Jancke L, Herrmann CS. Transcranial direct current stimulation 
39 
of the prefrontal cortex modulates working memory performance: combined behavioral and 
40 
electrophysiological evidence. . Neuroscience 2011;12:1-11. 
41 
11. 
Baddeley AD. Working memory and language: an overview. Journal of communication disorders 
42 
2003;36:189-208. 
43 
12. 
Cowan N. An embedded-processes model of working memory. In: Miyake A, Shah P, eds. 
44 
Models of Working Memory. Cambridge, UK: Cambridge University Press, 1999:62-101. 
45 
13. 
Ericsson KA, Kintsch W. Long-term working memory. Psychological Review 1995;102:211-245. 
46 
14. 
Murray LL. Direct and indirect treatment approaches for addressing short-term or working 
47 
memory deficits in aphasia. Aphasiology 2012;26:317-337. 
48 

11 
 
15. 
Wright HH, Fergadiotis G. Conceptualizing and measuring working memory relationship to 
1 
aphasia. Aphasiology 2012;26:258-278. 
2 
16. 
Baddeley AD. Working memory: theories, models and controversies. Annal Review of 
3 
Psychology 2012;63:1-29. 
4 
17. 
Abel S, Schultz A, Rademacher I, Willmes K, Huber W. Decreasing and increasing cues in naming 
5 
therapy for aphasia. Aphasiology 2005;19:831-848. 
6 
18. 
Freed D, Celery K, Marshall R. Effectiveness of personalized and phonological cueing on long-
7 
term naming performance by aphasic subjects: a clinical investigation. Aphasiology 2004;18:743-757. 
8 
19. 
Nickels L. Therapy for naming disorders: revisiting, revising and reviewing. Aphasiology 
9 
2002;16:935-979. 
10 
20. 
Wambaugh JL. A comparison of the relative effects of phonologic and semantic cueing 
11 
treatments. Aphasiology 2003;17:433-441. 
12 
21. 
Wambaugh JL, Linebaugh C, Doyle P, Martinez Z, Kaylinyak-Fliszar M, Spencer K. Effects of two 
13 
cueing treatments on lexical retrieval in aphasic speakers with different levels of deficit. . Aphasiology 
14 
2001;15:933-950. 
15 
22. 
Floel A, Meinzer M, Kirstein R, et al. Short-term anomia training and electrical brain stimulation 
16 
Stroke 2011;42:2065-2067. 
17 
23. 
Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke 
18 
patients with aphasia. Stroke 2010;41:1229-1236. 
19 
24. 
Vines BW, Norton AC, Schlaug G. Non-invasive brain stimulation enhances the effects of melodic 
20 
intonation therapy. Frontiers in Psychology 2011;2:1-10. 
21 
25. 
You DS, Kim DY, Chun MH, Jung SE, Park SJ. Cathodal transcranial direct current stimulation of 
22 
the right Wernicke's area improves comprehension in subacute stroke patients. . Brain Lang 2011;119:1-
23 
5. 
24 
26. 
Fridriksson J, Richardson JD, Baker JM, Rorden C. Transcranial direct current stimulation 
25 
improves naming reaction time in fluent aphasia: a double-blind, sham-controlled study. Stroke 
26 
2011;42:819-821. 
27 
27. 
Mulquiney PG, Hoy KE, Daskalakis ZJ, Fitzgerald PB. Improving working memory: Exploring the 
28 
effect of transcranial random noise stimulation and transcranial direct current stimulation on the 
29 
dorsolateral prefrontal cortex. Clinical Neruophysiology 2011;122:2384-2389. 
30 
28. 
Jo JM, Kim YH, Ko MH, Ohn SH, Joen B, Lee KH. Enhancing the working memory of stroke 
31 
patients using tDCS. American Journal of Physical Medicine & Rehabilitation 2009;88(5):404-409. 
32 
29. 
Code C, Herrmann M. The relevance of emotional and psychosocial factors in aphasia to 
33 
rehabilitation. Neuropsychological Rehabilitation 2003;13:109-132. 
34 
30. 
Cruice M, Worrall L, Hickson L, Murison R. Finding a focus for quality of life with aphasia: social 
35 
and emotional health and psychological well-being. Aphasiology 2003;17:333-353. 
36 
31. 
Fucetola R, Connor LT, Perry J, Leo P, Tucker FM, Corbetta M. Aphasia severity, semantics and 
37 
depression predict functional communication in acquired aphasia. Aphasiology 2006;20:449-461. 
38 
32. 
Hilari K, Needle JJ, Harrison KL. What are the important factors in health-related quality of life 
39 
for people with aphasia: a systematic review. . Archives of Physical Medicine & Rehabilitation 
40 
2012;93:S86-S95. 
41 
33. 
Cruice M, Hihll R, Worrall L, Hickson L. Conceptualising quality of life for older people with 
42 
aphasia. Aphasiology 2010;24:327-341. 
43 
34. 
Wright HH, Fergadiotis G. Conceptualising the measuring working memory relationship to 
44 
aphasia. Aphasiology 2012;26:258-278. 
45 
35. 
Jasper HH. The ten-twenty system electrode system of the International Federation. 
46 
Electroencephalography & Clinical Neurophysiology 1958;10:370-375. 
47 

12 
 
36. 
Elmer S, Burkard M, Renz B, Meyer M, Jancke L. Direct current induced short-term modulation 
1 
of the left dorsolateral prefrontal cortex while learning auditory presented nouns. . Behavioral and Brain 
2 
Functions 2009;5(29):1-7. 
3 
37. 
Beam W, Borckardt J, Reeves ST, George MS. An efficient and accurate new method for locating 
4 
the F3 position for prefrontal TMS applications. Brain Stimulation 2009;2:50-54. 
5 
38. 
Estes Z, Golonka S, Jones LL. Thematic thinking: the apprehension and consequences of thematic 
6 
relations. In: Ross B, ed. The Psychology and Learning and Motivation. Burlington: Academic Press, 2011. 
7 
39. 
Hutchinson KA. Is semantic priming due to association strength or feature overlap? A 
8 
microanalytic. . Psychonomic Bulletin & Review 2003;10:785-813. 
9 
40. 
McRae K, Cree GS, Seidenberg MS, McNorgan C. Semantic feature production norms for a large 
10 
set of living and nonliving things. Behavior Research Methods Instruments & Computers 2005;37:547-
11 
559. 
12 
41. 
Snodgrass JG, Vanderwart M. A stardnardized set of 260 pictures: norms for name agreement, 
13 
image agreement, familiarity and visual complexity. Human Learning and Memory 1980;6:174-215. 
14 
42. 
Baayen RH, Piepenbrock R, vanRijn H. The CELEX lexical database. In: 
15 
htt/://wwwlands2letkunnl/members/softward/celexhtml; 1993. 
16 
43. 
Kertesz A. Western Aphasia Bettery-Revised. . Sydney, Australia: Pearson Psychcorp, 2006. 
17 
44. 
Kaplan E, Goodglass H, Weintraub S. Boston Naming Test: Second Edition. Philadelphia, PA: 
18 
Lippincott Williams & Wilkins Publishers, 2001. 
19 
45. 
Dabul B. Apraxia Battery for Adults-Second Edition. Austin, TX: Pro-Ed, Inc, 2000. 
20 
46. 
Beeson PM, Robey RR. Evaluating single-subject treatment research: Lessons learned from the 
21 
aphasia literature. Neuropsychological Review 2006;16:161-169. 
22 
47. 
Busk PL, Serlin R. Single-case research design and analysis: New directions for pyschology and 
23 
education. In: Kratochwill RR, Levin JR, editors. Meta-analysis for single case research. Hillsdale, NJ: 
24 
Lawrence Erlbaum Associates; 1992. 
25 
 
26 
 
27