title: Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation: a randomized double-blind controlled pilot study.
abstract: BACKGROUND
  Functional neuroimaging studies with poststroke aphasia patients have shown increased activation of the unaffected hemisphere, which hypothetically reflects a maladaptive strategy of brain reorganization.
  
  
  OBJECTIVE
  We investigated whether repetitive transcranial magnetic stimulation (rTMS) inhibiting the right-hemisphere homologue of Broca's area improves language restitution if combined with speech/language therapy.
  
  
  METHODS
  Forty aphasic patients during the subacute phase of ischemic stroke were randomized to a 3-week aphasia rehabilitation protocol in combination with real or sham rTMS. Naming, repetition, and comprehension were assessed using the Boston Diagnostic Aphasia Examination at baseline, immediately after therapy, and 15 weeks after completing treatment.
  
  
  RESULTS
  Although language functions improved in both experimental and control groups after 3 weeks, only slight group differences in degree of recovery were revealed between patients receiving rTMS and control participants. Follow-up revealed that severely aphasic rTMS patients demonstrated significantly greater improvement than patients receiving sham stimulation in repetition.
  
  
  CONCLUSIONS
  Inhibitory rTMS applied to the right frontal language homologue is not effective for all poststroke aphasia patients, although it might benefit selected patients.
authors.affiliation: Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Seniów
authors.forename: Konrad
authors.initials: K
authors.lastname: Waldowski
authors.forename: Marcin
authors.initials: M
authors.lastname: Leśniak
authors.forename: Szczepan
authors.initials: S
authors.lastname: Iwański
authors.forename: Wojciech
authors.initials: W
authors.lastname: Czepiel
authors.forename: Anna
authors.initials: A
authors.lastname: Członkowska
mesh_terms: D000328:Adult; D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000534:rehabilitation*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007808:Language Therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013070:Speech Therapy; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation