Efficacy of synchronous verbal training during repetitive transcranial magnetic stimulation in patients with chronic aphasia.
OBJECTIVE
Although multiple studies have suggested that repetitive transcranial magnetic stimulation (rTMS) may facilitate recovery after stroke, the efficacy of synchronous speech therapy integrated with an rTMS protocol has yet to be determined. We investigated language responses to this strategy and determined the longevity of the resulting therapeutic outcomes.


METHODS
Forty-five patients with stroke who presented with nonfluent aphasia were randomly assigned to the TMSsyn group and underwent synchronous picture-naming training together with contralesional 1 Hz-rTMS for 10 daily sessions. The TMSsub group underwent subsequent picture-naming activity after the primed 1 Hz-rTMS, and the TMSsham group received concurrent naming task along with the sham 1 Hz-rTMS. The Concise Chinese Aphasia test and the picture-naming test were performed before, immediately, and after 3 months of the intervention.


RESULTS
TMSsyn showed significantly superior results in Concise Chinese Aphasia test score (P<0.001), expression and description subtests (P<0.001), and action (P=0.02) and object naming activity (P=0.008); the superior results lasted for 3 months (P=0.005), in comparison with the TMSsub and TMSsham groups.


CONCLUSIONS
We established a real-time model that involved implementing verbal tasks together with the rTMS protocol. Our results confirmed that the strategy yielded favorable outcomes that were of considerable longevity. The results also indicated that the rTMS protocol and language training can be combined to achieve outcomes superior to those obtained when used separately.


BACKGROUND
http://www.clinicaltrials.gov. Unique identifier: NCT02120508.
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.).
Chih-Pin
CP
Wang
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.).
Chin-Yi
CY
Hsieh
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.). pytsai@vghtpe.gov.tw.
Po-Yi
PY
Tsai
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.).
Chia-To
CT
Wang
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.).
Fu-Gong
FG
Lin
From the Department of Emergency Mackay Memorial Hospital, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-P.W., C.-Y.H.); Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (P.-Y.T., C.-T.W., R.-C.C.); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P.-Y.T., R.-C.C.); and School of Public Health, National Defense Medical Center, Taipei, Taiwan (F.-G.L.).
Rai-Chi
RC
Chan
D000328:Adult; D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000534:rehabilitation*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013070:Speech Therapy / Q000379:methods*; D020521:Stroke / Q000150:complications; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
aphasia; repetitive transcranial magnetic stimulation; stroke