Language improvements after TMS plus modified CILT: Pilot, open-protocol study with two, chronic nonfluent aphasia...

Area of Science:

• Neuroscience
• Speech-Language Pathology

Background:

• Chronic nonfluent aphasia following stroke presents significant communication challenges.
• Current therapeutic approaches for aphasia have varying degrees of efficacy.
• Investigating novel treatment combinations is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the feasibility of administering modified constraint-induced language therapy (mCILT) immediately after transcranial magnetic stimulation (TMS).
• To determine if this combined TMS and mCILT therapy enhances naming and propositional speech in individuals with chronic nonfluent aphasia.

Main Methods:

• Two patients with chronic nonfluent aphasia underwent a combined treatment protocol.
• The protocol involved 20 minutes of repetitive transcranial magnetic stimulation (rTMS) targeting the right pars triangularis, followed by 3 hours of mCILT daily for 2 weeks.
• Language assessments were conducted before and at 1-2 months, and 6 or 16 months post-treatment.

Main Results:

• Both participants demonstrated notable improvements in picture naming and elicited propositional speech at 1-2 months post-intervention.
• Sustained improvement in naming was observed at 6 months for one patient, but not at 16 months for the other.
• The feasibility of immediate post-TMS mCILT administration was confirmed.

Conclusions:

• Combining TMS with mCILT is a feasible therapeutic approach for nonfluent aphasia.
• The specific contribution of TMS versus mCILT to the observed speech improvements remains unclear.
• A larger, sham-controlled clinical trial is recommended to validate these preliminary findings and establish treatment efficacy.