Related Experiment Video
Updated: Jun 12, 2026
Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia
Published on: July 2, 2013
Transcranial Magnetic Stimulation Combined with Speech-Language Therapy for Post-Stroke Aphasia Recovery: A
Jine Lin1, Yangjuan Bao1, Min Fang1
1Department of Rehabilitation Medicine, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, People's Republic of China.
Background:
Speech-language therapy (SLT) is standard care for post-stroke aphasia (PSA), and adjunctive transcranial magnetic stimulation (TMS) may further improve language function. Which TMS protocol optimally complements SLT for which language domain at which time point remains unresolved, motivating this network meta-analysis.
Objective:
To compare TMS protocols combined with SLT across immediate and long-term language outcomes in post-stroke aphasia.
Methods:
Web of Science, EMBASE, PubMed, and the Cochrane Library were searched from inception to 24 January 2026 for randomized trials of TMS plus SLT in post-stroke aphasia. Bayesian network meta-analyses were run in R 4.4.2 with the gemtc and rjags packages, with outcomes grouped into seven immediate and four long-term language domains and effect sizes reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs). Treatments were ranked by the surface under the cumulative ranking curve (SUCRA), and certainty of evidence was rated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Results:
Across 26 trials enrolling 1,136 patients, three protocols led across the language domains. LF-rTMS+Music+SLT ranked first for immediate aphasia severity (SUCRA = 96.86%), repetition (97.25%), naming (99.69%), and spontaneous speech (95.67%); LF-rTMS+SLT, for writing (87.73%); and Dual-rTMS+SLT, for immediate functional communication (91.49%) and comprehension (97.57%). Dual-rTMS+SLT was also optimal across all four long-term outcomes (overall aphasia severity 95.82%, comprehension 95.06%, naming 99.74%, repetition 97.90%). Heterogeneity was low-to-moderate (moderate-to-high for immediate aphasia severity), and all Bayesian models converged (PSRF < 1.05). Evidence was moderate-to-high for standard comparisons (LF-rTMS+SLT vs SLT) but low to very low for the highest-ranked novel combinations such as LF-rTMS+Music+SLT, driven by imprecision and indirectness.
Conclusion:
The optimal TMS-plus-SLT protocol depends on which language domain and which time point matters. LF-rTMS+Music+SLT led the immediate domains, while Dual-rTMS+SLT led the long-term domains. Standard adjunctive comparisons (e.g. LF-rTMS+SLT vs SLT) rest on moderate-to-high certainty evidence, but the highest-ranked novel combinations rest on low-certainty evidence and require head-to-head confirmation.
