Impact of Neuromodulation on Language Impairments in Stroke Patients

Study Overview
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Brief Summary
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Up to 40% of stroke survivors suffer from aphasia, making recovery of language abilities a top priority in stroke rehabilitation. Conventional speech and language therapy may have limited effectiveness. Leveraging multimodal data (behavioral, neuroimaging, and genetics), this study aims to 1) evaluate the efficacy of combining tDCS with speech therapy, 2) examine neural changes associated with recovery, 3) identify factors influencing response to treatment.

Detailed Description
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Approximately one million people in the United States are living with aphasia, an acquired neurological disorder affecting the ability to use and/or understand language. This communication impairment affects up to 40% of stroke patients. Stroke victims usually prioritize speaking, writing, and walking as the three most important rehabilitation goals, two of these goals therefore involving communication. Conventional speech therapy strategies have nevertheless limited effectiveness in post-stroke aphasia. Indeed, approximately half of those affected will remain in this state despite intensive speech therapy. Effective novel treatment is therefore warranted to improve recovery in these patients. Recent evidence suggests that transcranial direct current stimulation (tDCS), a non-invasive, low-cost neuromodulation technique, applied in conjunction with speech therapy may be more effective in promoting language recovery than behavioral intervention alone. A double-blind quasi-randomized controlled study will be carried out in chronic post-stroke aphasics. Participants will be assigned to either the tDCS group or to the sham (placebo) group and will receive 20 minutes of concurrent speech and language therapy by a trained speech therapist over five consecutive days. Behavioral, EEG, and MRI data will be acquired within one week before and after intervention. Genetic samples will be collected once. Secondary behavioral outcome measures will be performed again 3 months following tDCS/sham intervention to assess long-term benefits.

Official Title
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Impact of Neuromodulation on Language Impairments in Stroke Patients: a Multimodal Double-blind Randomized Controlled Study

Conditions
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Stroke, Aphasia

Intervention / Treatment
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* Device: tDCS
* Behavioral: Speech and language therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between ages 18-85 At least 12 months post stroke Diagnosed with aphasia due to ischemic or hemorrhagic stroke English speaking Right handed prior to stroke Exclusion Criteria: Nonverbal Other neurological diseases/disorders Not MRI-compatible (e.g. claustrophobia, metal implants in the head)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: double-blind quasi-randomized controlled design
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: tDCS + speech therapy<br>Participants will receive 20 minutes of anodal tDCS paired with speech and language therapy over five consecutive days. | Device: tDCS<br>* Anodal or sham tDCS will be applied to the scalp.<br>Behavioral: Speech and language therapy<br>* A trained speech pathologist will administer the speech and language therapy.<br>|
| Sham Comparator: sham + speech therapy<br>Participants will receive 20 minutes of sham tDCS paired with speech and language therapy over five consecutive days. | Device: tDCS<br>* Anodal or sham tDCS will be applied to the scalp.<br>Behavioral: Speech and language therapy<br>* A trained speech pathologist will administer the speech and language therapy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Western Aphasia Battery-Revised scores | WAB-R is an instrument for assessing the language function of adults with suspected neurological disorders as a result of a stroke. | At baseline and at week 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Magnetic Resonance Imaging (MRI) | MRI scans will be acquired on a Siemens Magnetom Verio 3T Scanner at Casa Colina Imaging Center to assess structural changes. | At baseline and at week 3 | 
| Change in resting state Electroencephalograph (EEG) signals | Using a B-Alert wireless EEG system, we will perform eyes-open resting-state EEG recordings to assess power spectral density changes. | At baseline and at week 3 | 
| Change in Test of Nonverbal Intelligence (TONI-4) | TONI-4 is a language-free intelligence test for evaluating those with limited language ability. | At baseline and at week 3 | 
| Change in Communication Outcomes after Stroke (COAST) | The COAST is used to assess self-perceived communication effectiveness for people with aphasia. | At baseline, at week 3, and at week 17 | 
| Change in Patient-Reported Outcomes Measurement Information System (PROMIS) | PROMIS is used to assess physical, mental, and social health. | At baseline, at week 3, and at week 17 | 
| Change in Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) | The SAQOL-39 is used to assess health-related quality of life in people with long-term aphasia. | At baseline, at week 3, and at week 17 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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transcranial direct current stimulation, stroke, aphasia, speech therapy, neurorehabilitation, neuromodulation, language function, neuroplasticity, neuroimaging, EEG, MRI, genetics, language disorders