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Treatment of Aphasia Combining Neuromodulation and Behavioral Intervention: Taking an Impairment and Functional Approach

Elizabeth E. Galletta1, 2* and Amy Vogel2
  • 1 Hunter College, The City University of New York, Speech-Language Pathology & Audiology, United States
  • 2 Graduate Center, The City University of New York, Ph D Program in Speech-Language-Hearing Sciences, United States

Background Current treatment of aphasia involves behavioral speech-language intervention, yet many people continue to have significant communication impairments even after a course of speech-language treatment. Therefore, there is a continued need to develop new treatments to address the persistent speech and language deficits of stroke survivors. One such development that is quickly gaining traction as an adjunctive therapy to traditional speech and language treatment is transcranial direct current stimulation (tDCS), a non-invasive procedure that involves the stimulation of the cerebral cortex by way of a weak electrical current (Nitsche et al., 2003; Iyer et al., 2005). The mechanism supporting the use of tDCS is that learning, facilitated by speech-language intervention, can be enhanced by brain plasticity. The underlying biological mechanisms associated with neuroplasticity, and thereby the improvement of linguistic functioning in the recovering brain is still under investigation-- including among therapists working behaviorally with stroke survivors with aphasia (Galletta et al., 2011). This study focused on combining neuromodulation with an efficacious and ecologically-valid behavioral therapy. No tDCS studies to date have utilized a behavioral treatment approach that includes naming and discourse, yet in real life communication, naming occurs more often in the discourse context than in single words in isolation. As well, no previous study has included the production of nouns and verbs in sentences as outcome measures. Method Participant: A 43 year-old, right-handed stroke survivor who sustained a left hemisphere stroke was recruited. Baseline testing indicated a word retrieval deficit for nouns and verbs. Treatment: Instrumentation included the Soterix Medical 1x1 tDCS Device designed to be used for research to administer tDCS. Behavioral treatment materials included sentence production training (Helm-Estabrooks and Nicholas, 2001), naming in the sentence context (based on Raymer and Kohen, 2006), and implementation of a social, conversational treatment (based on Simmons-Mackie et al. 2001). See example of treatment schedule (Figure 1) below. These materials were created and piloted prior to this study (Galletta et al., 2013). Figure 1: Schematic of treatment schedule. Behavioral treatment order alternated each session. Design and Procedures: The independent variable of this double-blind crossover study was tDCS intervention, and the dependent variables were speech and language abilities, and health-related quality-of-life measures. The subject received sixty-minutes of speech-language treatment with the first twenty minutes additionally including tDCS. Results Baseline measures of naming nouns and verbs in single words, and sentences, were obtained. While there was no improvement in production of nouns or verbs in single words or sentence production after sham tDCS, and no improvement of noun production after anodal tDCS and speech-language treatment, production of verbs in sentences improved after a 10-session treatment block of anodal tDCS and behavioral therapy. Conclusion Administering a behavioral treatment that is impairment-based as well as functionally-based in conjunction with tDCS is both feasible and promising. Anodal tDCS in conjunction with behavioral intervention is a treatment approach that warrants continued investigation. The results will be discussed in relation to the tDCS and aphasia literature.

Figure 1
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Acknowledgements

PSC CUNY Traditional B Award to Elizabeth E. Galletta

References

References
Galletta, E., Rao. P. & Barrett, A.M. (2011). Transcranial magnetic stimulation (TMS): Potential progress for language improvement in aphasia. Top Stroke Rehabil, Mar-Apr;18(2):87-91.

Galletta, E., Vogel, A., & Baumann, S. (2013) Talking and tDCS treatment for stroke
survivors with aphasia [abstract]. In: NYC Neuromodulation.; November 22-23, 2013; New York, NY. New York, NY: Brain Stimulation; TBD, 2014. 12.16.

Helm-Estabrooks N. & Nicholas, M. (2001). Sentence production program for aphasia. Austin, TX: Pro-Ed.

Iyer, M. B., Mattu, U., Grafman, J., Lomarev, M., Sato, S., & Wassermann, E. M. (2005). Safety and cognitive effect of frontal DC brain polarization in healthy individuals.
Neurology,64(5), 872–875.

Nitsche, M. A., Fricke, K., Henschke, U., Schlitterlau, A., Liebetanz, D., Lang, N., et al. (2003). Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. Journal of Physiology, 553, 293–301.

Raymer, A. & Kohen, F. (2006). Word-retrieval treatment in aphasia: Effects of sentence context. J of Rehabil Res & Devel, 43(3), 367-378.

Simmons-Mackie, N. (2001). Social approaches to aphasia intervention. In R. Chapey (Ed.) Language intervention strategies in aphasia and related neurogenic communication disorders (4th ed., pp. 246-268). Philadelphia: Lippincott, Williams, & Wilkins.

Keywords: Aphasia, tDCS, neuromoduation, intervention, Stroke, Recovery of Function

Conference: Academy of Aphasia -- 52nd Annual Meeting, Miami, FL, United States, 5 Oct - 7 Oct, 2014.

Presentation Type: Poster presentation ONLY

Topic: Not student

Citation: Galletta EE and Vogel A (2014). Treatment of Aphasia Combining Neuromodulation and Behavioral Intervention: Taking an Impairment and Functional Approach. Front. Psychol. Conference Abstract: Academy of Aphasia -- 52nd Annual Meeting. doi: 10.3389/conf.fpsyg.2014.64.00064

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Received: 25 Apr 2014; Published Online: 04 Aug 2014.

* Correspondence: Dr. Elizabeth E Galletta, Hunter College, The City University of New York, Speech-Language Pathology & Audiology, NY, New York, 10010, United States, elizabeth.galletta@gmail.com