Publications by authors named "Paola Marangolo"

55 Publications

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety.

Brain Sci 2021 Jan 2;11(1). Epub 2021 Jan 2.

Aphasia Laboratory, IRCCS Santa Lucia Foundation, 00179 Rome, Italy.

Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.
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http://dx.doi.org/10.3390/brainsci11010041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823462PMC
January 2021

Does COVID-19 Impact Less on Post-stroke Aphasia? This Is Not the Case.

Front Psychol 2020 30;11:564717. Epub 2020 Nov 30.

Dipartimento di Studi Umanistici, University of Naples Federico II, Naples, Italy.

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected people's mental health resulting in severe psychological consequences. One of the leading causes of long-term disability worldwide is aphasia. The language changes experienced by a person with aphasia (PWA) often have a sudden and long-lasting negative impact on social interaction, quality of life, and emotional wellbeing. The main aim of this study was to investigate the impact of COVID-19 on the different psychosocial dimensions which affect PWA.

Methods: This retrospective study included 73 PWA and 81 elderly matched controls. All patients were in the chronic phase. They were all discharged from rehabilitation services, which left them with different degrees of language deficits (i.e., severe vs. mild vs. moderate). All participants were administered the hospital anxiety and depression scale (HADS) through an online survey. PWA also took part in the stroke and aphasia quality of life scale questionnaire (SAQOL-39).

Results: Although the comparison between two different time points [one month before (T0) and one month after the lockdown (T1)] led to a significant increase in depression and anxiety symptoms in both groups (PWA vs. control), lower rates of depression and anxiety were found in PWA compared to the healthy group. Significant deterioration was also present in PWA in the communication and psychosocial scales of the SAQOL-39 test, which correlated with the observed changes in the psychological domains. Interestingly, the results were not significantly influenced by the degree of aphasia severity. Similarly, in both groups, none of the demographic variables (gender, age, and educational level) significantly affected the scores in the different subscales.

Conclusions: This evidence which, at first glance, seems to suggest that PWA have been partially spared from the impact of COVID-19, actually masks a dramatic situation that has always characterized this population. Indeed, given that PWA already live in a state of social isolation and emotional instability, these conditions might have, paradoxically, limited the effects of the coronavirus. However, as our results showed a deterioration in the emotional state and communication skills of our patients, possible solutions are discussed in order to prevent further decline of their cognitive abilities.
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http://dx.doi.org/10.3389/fpsyg.2020.564717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733932PMC
November 2020

Spinal or cortical direct current stimulation: Which is the best? Evidence from apraxia of speech in post-stroke aphasia.

Behav Brain Res 2021 Feb 15;399:113019. Epub 2020 Nov 15.

Department of Humanities studies - University Federico II, Naples, Italy; IRCCS Santa Lucia Foundation, Rome, Italy. Electronic address:

To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.
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http://dx.doi.org/10.1016/j.bbr.2020.113019DOI Listing
February 2021

Can Alzheimer's Disease Be Prevented? First Evidence from Spinal Stimulation Efficacy on Executive Functions.

J Alzheimers Dis 2020 ;77(4):1755-1764

Department of Humanities studies - University Federico II, Naples, Italy.

Background: Recently, a growing body of evidence has shown that, from the early stage of impairment, Alzheimer's patients (AD) present difficulties on a variety of tasks mostly relying on executive functions. These strongly impact their daily life activities causing a severe loss of independency and autonomy.

Objective: To evaluate the efficacy of transpinal direct current stimulation (tsDCS) combined with cognitive trainings for improving attentional and executive function abilities in a group of AD patients.

Methods: In a randomized-double blind design, sixteen AD patients underwent different cognitive trainings combined with tsDCS. During the treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (IX-X vertebrae) in two different conditions: 1) anodal, and 2) sham while performing three computerized tasks: alertness, selective attention, and executive functions. Each experimental condition was run in ten consecutive daily sessions over two weeks.

Results: After anodal tsDCS, a greater improvement in executive functions compared to sham condition was found. More importantly, the follow-up testing revealed that these effects lasted over 1 month after the intervention and generalized to the different neuropsychological tests administered before, after the treatment and at one month after the end of the intervention. This generalization was present also in the attentional domain.

Conclusion: This evidence emphasizes, for the first time, that tsDCS combined with cognitive training results efficacious for AD patients. We hypothesize that enhancing activity into the spinal sensorimotor pathways through stimulation improved cognitive abilities which rely on premotor activity, such as attention and executive functions.
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http://dx.doi.org/10.3233/JAD-200695DOI Listing
January 2020

Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation (tDCS) in neurological and psychiatric disorders.

Int J Neuropsychopharmacol 2020 Jul 26. Epub 2020 Jul 26.

Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Background: Transcranial direct current stimulation (tDCS) has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects.

Objective: We convened a team of tDCS experts to conduct a systematic review of clinical trials with more than one session of stimulation testing: Pain, Parkinson's Disease Motor Function and Cognition, Stroke Motor Function and Language, Epilepsy, Major Depressive Disorder, Obsessive-Compulsive Disorder, Tourette Syndrome, Schizophrenia and Drug Addiction.

Methods: Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into: Levels A (definitely effective), B (probably effective), C (possibly effective) or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies.

Results: Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A) such as depression, probably effective (Level B) such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson´s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with largest effect size being in postoperative acute pain, and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy).

Conclusion: All recommendations listed here are based on current published Pubmed-indexed data. Despite high level of evidence in some conditions, it needs to be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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http://dx.doi.org/10.1093/ijnp/pyaa051DOI Listing
July 2020

Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic.

Brain Stimul 2020 Jul - Aug;13(4):1124-1149. Epub 2020 May 12.

Laureate Institute for Brain Research, Tulsa, OK, USA. Electronic address:

Background: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19.

Objective: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS).

Methods: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics.

Results: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described.

Conclusion: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.
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http://dx.doi.org/10.1016/j.brs.2020.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217075PMC
July 2020

Conversational Therapy in Aphasia: From Behavioral Intervention to Neuromodulation.

Semin Speech Lang 2020 01 23;41(1):61-70. Epub 2019 Dec 23.

Department of Humanities Studies, University Federico II, Naples, Italy.

This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.
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http://dx.doi.org/10.1055/s-0039-3399500DOI Listing
January 2020

Stairways to the brain: Transcutaneous spinal direct current stimulation (tsDCS) modulates a cerebellar-cortical network enhancing verb recovery.

Brain Res 2020 01 22;1727:146564. Epub 2019 Nov 22.

IMT Scuola Alti Studi Lucca, 55100, Lucca, Italy. Electronic address:

It has long been assumed that the language function is hierarchically organized into specific cortical areas. Here, for the first time, we present direct evidence that the spinal cord takes part in language processing. In a randomized-double blind design, sixteen aphasics underwent a language treatment combined with transcutaneous spinal direct current stimulation (tsDCS). During the treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (IX-X vertebrae) in two different conditions: (1) anodal, and (2) sham while performing a verb naming task. Each experimental condition was run in five consecutive daily sessions over two weeks. Before and after each condition, all patients underwent a resting state functional magnetic resonance imaging (rs-fMRI). After anodal tsDCS, significant functional connectivity changes were found in a cerebellar-cortical network recruiting regions such as the left cerebellum, the right parietal and premotor cortex known to be also involved in action-related verb processing. Indeed, this increase of connectivity significantly correlated with the greatest amount of improvement found in verb naming. In line with our experimental data, we also found a greater improvement after anodal tsDCS also on untreated items of the language test but only on tasks which required the use of verbs, such as verb naming and picture description. No significant changes were found in noun naming. Thus, this evidence emphasizes, for the first time, that the neural response due to tsDCS combined with language treatment changes during the course of recovery by enhancing activity into cortical regions which influence verb processing.
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http://dx.doi.org/10.1016/j.brainres.2019.146564DOI Listing
January 2020

High-Definition Transcranial Direct Current Stimulation Improves Verb Recovery in Aphasic Patients Depending on Current Intensity.

Neuroscience 2019 05 12;406:159-166. Epub 2019 Mar 12.

IRCCS, Fondazione Santa Lucia, Rome, Italy; Università Federico II, Naples, Italy. Electronic address:

High-definition transcranial direct current stimulation (HD-tDCS) is a variant of tDCS, which produces more focal stimulation, delimiting brain current flow to a defined region compared to conventional tDCS. To date, only one study has been conducted to investigate HD-tDCS effects on language recovery in aphasia. Here, we aimed to assess the effects of cathodal HD-tDCS on verb naming by comparing two current intensities: 1 vs 2 mA. In a double-blinded cross over study, two groups of 10 aphasic individuals were submitted to active cathodal HD-tDCS and sham stimulation over the right homolog of Broca's area, while performing a verb naming task. Indeed, we reasoned that, by applying inhibitory current over the right Broca's area, we would decrease the inhibitory impact from the right hemisphere to the left perilesional cortex, thus boosting language recovery. The groups differed in the intensity of the active stimulation (1 mA or 2 mA). In both groups, each condition was carried out in five consecutive daily sessions with one week of interval between the two experimental conditions. A significant improvement in verb naming was found only after cathodal HD-tDCS at 2 mA, which endured one week after the end of treatment. The improvement was not observed on the group receiving cathodal HD-tDCS at 1 mA. Our findings showed that HD-tDCS applied to the right intact hemisphere are efficacious for language recovery. These results indicate that HD-tDCS represents a promising new technique for language rehabilitation. However, systematic determination of stimulation intensity appears to be crucial for obtaining relevant effects.
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http://dx.doi.org/10.1016/j.neuroscience.2019.03.010DOI Listing
May 2019

Transcranial direct current stimulation (tDCS) facilitates verb learning by altering effective connectivity in the healthy brain.

Neuroimage 2018 11 17;181:550-559. Epub 2018 Jul 17.

Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. Electronic address:

Recent studies have shown that the left inferior frontal gyrus (IFG) plays a key role in language learning. Facilitatory stimulation over this region by means of anodal transcranial direct current stimulation (tDCS) can modulate linguistic abilities in healthy individuals and improve language performance in patients with post-stroke aphasia. Neuroimaging studies in healthy participants have suggested that anodal tDCS decreases task-related activity at the stimulated site when applied during different language tasks, and changes resting-state connectivity in a larger network of areas associated with language processing. However, to date, the neural correlates of the potential beneficial effects of tDCS on verb learning remain unclear. The current study investigated how anodal tDCS during verb learning modulates task-related activity and effective connectivity in the healthy language network. To this end, we combined a verb learning paradigm during functional neuroimaging with simultaneous tDCS over the left IFG in healthy human volunteers. We found that, relative to sham stimulation, anodal tDCS significantly decreased task-related activity at the stimulated left IFG and in the right homologue. Effective connectivity analysis showed that anodal tDCS significantly decreased task-related functional coupling between the left IFG and the right insula. Importantly, the individual decrease in connectivity was significantly correlated with the individual behavioural improvement during anodal tDCS. These results demonstrate, for the first time, that the behavioural improvements induced by anodal tDCS might be related to an overall decrease in processing effort both with respect to task-related activity and effective connectivity within a large language network.
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http://dx.doi.org/10.1016/j.neuroimage.2018.07.040DOI Listing
November 2018

The potential effects of transcranial direct current stimulation (tDCS) on language functioning: Combining neuromodulation and behavioral intervention in aphasia.

Authors:
Paola Marangolo

Neurosci Lett 2020 02 28;719:133329. Epub 2017 Dec 28.

Università Federico II, Napoli & IRCCS Fondazione Santa Lucia, Roma, Italy. Electronic address:

Aphasia is a highly disabling language disorder usually caused by a left stroke brain damage. Even if traditional language therapies have been proved to induce an adequate clinical recovery, a large percentage of patients are left with chronic deficits at 6 months post-stroke. Therefore, new strategies to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of transcranial direct current stimulation (tDCS) to language rehabilitation has already provided promising results. This brief review gives an overview of the most important results achieved using this approach and discusses how the application of this treatment might potentiate aphasia recovery.
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http://dx.doi.org/10.1016/j.neulet.2017.12.057DOI Listing
February 2020

Incomplete evidence that increasing current intensity of tDCS boosts outcomes.

Brain Stimul 2018 Mar - Apr;11(2):310-321. Epub 2017 Dec 13.

Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA.

Background: Transcranial direct current stimulation (tDCS) is investigated to modulate neuronal function by applying a fixed low-intensity direct current to scalp.

Objectives: We critically discuss evidence for a monotonic response in effect size with increasing current intensity, with a specific focus on a question if increasing applied current enhance the efficacy of tDCS.

Methods: We analyzed tDCS intensity does-response from different perspectives including biophysical modeling, animal modeling, human neurophysiology, neuroimaging and behavioral/clinical measures. Further, we discuss approaches to design dose-response trials.

Results: Physical models predict electric field in the brain increases with applied tDCS intensity. Data from animal studies are lacking since a range of relevant low-intensities is rarely tested. Results from imaging studies are ambiguous while human neurophysiology, including using transcranial magnetic stimulation (TMS) as a probe, suggests a complex state-dependent non-monotonic dose response. The diffusivity of brain current flow produced by conventional tDCS montages complicates this analysis, with relatively few studies on focal High Definition (HD)-tDCS. In behavioral and clinical trials, only a limited range of intensities (1-2 mA), and typically just one intensity, are conventionally tested; moreover, outcomes are subject brain-state dependent. Measurements and models of current flow show that for the same applied current, substantial differences in brain current occur across individuals. Trials are thus subject to inter-individual differences that complicate consideration of population-level dose response.

Conclusion: The presence or absence of simple dose response does not impact how efficacious a given tDCS dose is for a given indication. Understanding dose-response in human applications of tDCS is needed for protocol optimization including individualized dose to reduce outcome variability, which requires intelligent design of dose-response studies.
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http://dx.doi.org/10.1016/j.brs.2017.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050474PMC
February 2019

Transcranial Cerebellar Direct Current Stimulation Enhances Verb Generation but Not Verb Naming in Poststroke Aphasia.

J Cogn Neurosci 2018 02 24;30(2):188-199. Epub 2017 Oct 24.

Università degli Studi di Milano, Milan, Italy.

Although the role of the cerebellum in motor function is well recognized, its involvement in the lexical domain remains to be further elucidated. Indeed, it has not yet been clarified whether the cerebellum is a language structure per se or whether it contributes to language processing when other cognitive components (e.g., cognitive effort, working memory) are required by the language task. Neuromodulation studies on healthy participants have suggested that cerebellar transcranial direct current stimulation (tDCS) is a valuable tool to modulate cognitive functions. However, so far, only a single case study has investigated whether cerebellar stimulation enhances language recovery in aphasic individuals. In a randomized, crossover, double-blind design, we explored the effect of cerebellar tDCS coupled with language treatment for verb improvement in 12 aphasic individuals. Each participant received cerebellar tDCS (20 min, 2 mA) in four experimental conditions: (1) right cathodal and (2) sham stimulation during a verb generation task and (3) right cathodal and (4) sham stimulation during a verb naming task. Each experimental condition was run in five consecutive daily sessions over 4 weeks. At the end of treatment, a significant improvement was found after cathodal stimulation only in the verb generation task. No significant differences were present for verb naming among the two conditions. We hypothesize that cerebellar tDCS is a viable tool for recovery from aphasia but only when the language task, such as verb generation, also demands the activation of nonlinguistic strategies.
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http://dx.doi.org/10.1162/jocn_a_01201DOI Listing
February 2018

Moving Beyond the Brain: Transcutaneous Spinal Direct Current Stimulation in Post-Stroke Aphasia.

Front Neurol 2017 8;8:400. Epub 2017 Aug 8.

Clinica Neurologica III, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.

Over the last 20 years, major advances in cognitive neuroscience have clearly shown that the language function is not restricted into the classical language areas but it involves brain regions, which had never previously considered. Indeed, recent lines of evidence have suggested that the processing of words associated to motor schemata, such as action verbs, modulates the activity of the sensorimotor cortex, which, in turn, facilitates its retrieval. To date, no studies have investigated whether the spinal cord, which is functionally connected to the sensorimotor system, might also work as an auxiliary support for language processing. We explored the combined effect of transcutaneous spinal direct current stimulation (tsDCS) and language treatment in a randomized double-blind design for the recovery of verbs and nouns in 14 chronic aphasics. During each treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (10th vertebra) in three different conditions: (1) anodic, (2) cathodic and (3) sham, while performing a verb and noun naming tasks. Each experimental condition was run in five consecutive daily sessions over 3 weeks. Overall, a significant greater improvement in verb naming was found during the anodic condition with respect to the other two conditions, which persisted at 1 week after the end of the treatment. No significant differences were present for noun naming among the three conditions. The hypothesis is advanced that anodic tsDCS might have influenced activity along the ascending somatosensory pathways, ultimately eliciting neurophysiological changes into the sensorimotor areas which, in turn, supported the retrieval of verbs. These results further support the evidence that action words, due to their sensorimotor semantic properties, are partly represented into the sensorimotor cortex. Moreover, they also document, for the first time, that tsDCS enhances verb recovery in chronic aphasia and it may represent a promising new tool for language treatment.
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http://dx.doi.org/10.3389/fneur.2017.00400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550684PMC
August 2017

Different Cognitive Profiles of Patients with Severe Aphasia.

Behav Neurol 2017 29;2017:3875954. Epub 2017 May 29.

Lab of Applied Psychology and Intervention, Department of History Society and Human Studies, University of Salento, Lecce, Italy.

Cognitive dysfunction frequently occurs in aphasic patients and primarily compromises linguistic skills. However, patients suffering from severe aphasia show heterogeneous performance in basic cognition. Our aim was to characterize the cognitive profiles of patients with severe aphasia and to determine whether they also differ as to residual linguistic abilities. We examined 189 patients with severe aphasia with standard language tests and with the CoBaGA (Cognitive Test Battery for Global Aphasia), a battery of nonverbal tests that assesses a wide range of cognitive domains such as attention, executive functions, intelligence, memory, visual-auditory recognition, and visual-spatial abilities. Twenty patients were also followed longitudinally in order to assess their improvement in cognitive skills after speech therapy. Three different subgroups of patients with different types and severity of cognitive impairment were evidenced. Subgroups differed as to residual linguistic skills, in particular comprehension and reading-writing abilities. Attention, reasoning, and executive functions improved after language rehabilitation. This study highlights the importance of an extensive evaluation of cognitive functions in patients with severe aphasia.
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http://dx.doi.org/10.1155/2017/3875954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467392PMC
April 2018

Differential effects of bihemispheric and unihemispheric transcranial direct current stimulation in young and elderly adults in verbal learning.

Behav Brain Res 2017 03 3;321:170-175. Epub 2017 Jan 3.

IRCCS Fondazione Santa Lucia, Roma, Italy; Dipartimento di Studi Umanistici, Università Federico II, Napoli, Italy. Electronic address:

For the past few years, the potential of transcranial direct current stimulation (tDCS) for the treatment of several pathologies has been investigated. In the language domain, several studies, in healthy and brain-damaged populations, have already shown that tDCS is effective in enhancing naming, repetition and semantic word generation. In those studies, different tDCS electrode configurations have been tested, however, a direct comparison between different montages in verbal learning has never been conducted. In this study, we aimed to explore the impact of bihemispheric and unihemispheric tDCS on verbal learning task performance in two groups (young vs. elderly). Fifteen healthy volunteers participated per group. Each participant received three stimulation conditions: unihemispheric anodal tDCS over the left temporal area, bihemispheric tDCS over the left (anodal) and right (cathodal) temporal areas and a sham condition. During active stimulation, tDCS (20min, 2mA) was applied while each participant learned twenty pseudowords (arbitrarily assigned to corresponding pictures). No significant differences were found between the three conditions for the young group with regard to accuracy and vocal reaction times. In contrast, in the elderly group, real stimulation improved performance compared to sham but bihemispheric tDCS was more efficient than unilateral stimulation. These results suggest that bihemispheric stimulation is more effective in improving language learning but this effect is age-dependent. The hypothesis is advanced that cortical changes in the course of aging might differentially impact on tDCS efficacy on behavioral performance. These data may also have implications for treatment of stroke patients with language impairment.
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http://dx.doi.org/10.1016/j.bbr.2016.12.044DOI Listing
March 2017

Use of tDCS in Aphasia Rehabilitation: A Systematic Review of the Behavioral Interventions Implemented With Noninvasive Brain Stimulation for Language Recovery.

Am J Speech Lang Pathol 2016 12;25(4S):S854-S867

Dipartimento di Studi Umanistici, Università Federico II, Napoli, Italy and IRCCS Fondazione Santa Lucia, Roma, Italy.

Purpose: The purpose of this article is to review the behavioral treatments used in aphasia rehabilitation research that have been combined with transcranial direct current stimulation (tDCS). Although tDCS in aphasia treatment has shown promise, the results have not been conclusive, and their interpretation is further compounded by the heterogeneity of study characteristics. Because implementing a behavioral task during brain stimulation has been shown to be pivotal to the adjuvant effects of tDCS, we analyze the behavioral treatments that have been paired with tDCS.

Method: A computerized database search (PubMed) was completed to document and review aphasia treatment studies that combine behavioral treatment with noninvasive brain stimulation in the form of tDCS. Two authors reviewed each aphasia tDCS article published between 2008 and 2015 and evaluated (a) the behavioral interventions for aphasia that have been combined with tDCS, and (b) the methodological variables that may have influenced language outcomes in the tDCS aphasia literature.

Conclusions: A review of the behavioral treatments implemented in tDCS aphasia rehabilitation studies highlights several methodological considerations for future investigations. Impairment-focused and pragmatic treatments have been implemented in tDCS aphasia research studies. No one behavioral approach stands out as the best treatment to combine with tDCS for the promotion of language recovery.
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http://dx.doi.org/10.1044/2016_AJSLP-15-0133DOI Listing
December 2016

Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

Clin Neurophysiol 2017 Jan 29;128(1):56-92. Epub 2016 Oct 29.

Department of Clinical Neurophysiology, University Medical Center, Georg-August University, Göttingen, Germany.

A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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http://dx.doi.org/10.1016/j.clinph.2016.10.087DOI Listing
January 2017

Right sensory-motor functional networks subserve action observation therapy in aphasia.

Brain Imaging Behav 2017 Oct;11(5):1397-1411

IRCCS Fondazione Santa Lucia, Rome, Italy.

Recent studies have shown that the systematic and repetitive observation of actions belonging to the experiential human motor repertoire without verbal facilitation enhances the recovery of verbs in non fluent aphasia. However, it is still an open question whether this approach extends its efficacy also on discourse productivity by improving the retrieval of other linguistic units (i.e. nouns, sentences, content words). Moreover, nothing is known regarding the neural substrates which support the language recovery process due to action observation treatment.In the present study, ten non fluent aphasics were presented with two videoclips (real everyday life context vs. familiar pantomimed context), each video for six consecutive weeks (Monday to Friday, weekend off). During the treatment, they were asked to observe each video and to describe it without verbal facilitation from the therapist. In all patients, language measures were collected before and at the end of treatment. Before and after each treatment condition (real vs. pantomimed context), each subject underwent a resting state fMRI. After the treatment, significant changes in functional connectivity were found in right sensory-motor networks which were accompanied by a significant improvement for the different linguistic units in the real context condition. On the contrary, the language recovery obtained in the pantomimed context did not match any functional modification. The evidence for a recruitment of the sensory-motor cortices during the observation of actions embedded in real context suggests to potentially enhance language recovery in non fluent aphasia through a simulation process related to the sensory-motor properties of actions.
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http://dx.doi.org/10.1007/s11682-016-9635-1DOI Listing
October 2017

Bilateral Transcranial Direct Current Stimulation Language Treatment Enhances Functional Connectivity in the Left Hemisphere: Preliminary Data from Aphasia.

J Cogn Neurosci 2016 May 25;28(5):724-38. Epub 2016 Jan 25.

IRCCS Fondazione Santa Lucia, Rome, Italy.

Several studies have already shown that transcranial direct current stimulation (tDCS) is a useful tool for enhancing recovery in aphasia. However, no reports to date have investigated functional connectivity changes on cortical activity because of tDCS language treatment. Here, nine aphasic persons with articulatory disorders underwent an intensive language therapy in two different conditions: bilateral anodic stimulation over the left Broca's area and cathodic contralesional stimulation over the right homologue of Broca's area and a sham condition. The language treatment lasted 3 weeks (Monday to Friday, 15 sessions). In all patients, language measures were collected before (T0) and at the end of treatment (T15). Before and after each treatment condition (real vs. sham), each participant underwent a resting-state fMRI study. Results showed that, after real stimulation, patients exhibited the greatest recovery not only in terms of better accuracy in articulating the treated stimuli but also for untreated items on different tasks of the language test. Moreover, although after the sham condition connectivity changes were confined to the right brain hemisphere, real stimulation yielded to stronger functional connectivity increase in the left hemisphere. In conclusion, our data provide converging evidence from behavioral and functional imaging data that bilateral tDCS determines functional connectivity changes within the lesioned hemisphere, enhancing the language recovery process in stroke patients.
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http://dx.doi.org/10.1162/jocn_a_00927DOI Listing
May 2016

Use of Computational Modeling to Inform tDCS Electrode Montages for the Promotion of Language Recovery in Post-stroke Aphasia.

Brain Stimul 2015 Nov-Dec;8(6):1108-15. Epub 2015 Jul 2.

Dipartimento di Studi Umanistici, Università Federico II, Napoli, Italy; IRCSS Fondazione Santa Lucia, Rome, Italy. Electronic address:

Background: Although pilot trials of transcranial direct current stimulation (tDCS) in aphasia are encouraging, protocol optimization is needed. Notably, it has not yet been clarified which of the varied electrode montages investigated is the most effective in enhancing language recovery.

Objective: To consider and contrast the predicted brain current flow patterns (electric field distribution) produced by varied 1×1 tDCS (1 anode, 1 cathode, 5 × 7 cm pad electrodes) montages used in aphasia clinical trials.

Methods: A finite element model of the head of a single left frontal stroke patient was developed in order to study the pattern of the cortical EF magnitude and inward/outward radial EF under five different electrode montages: Anodal-tDCS (A-tDCS) over the left Wernicke's area (Montage A) and over the left Broca's area (Montage B); Cathodal tDCS (C-tDCS) over the right homologue of Wernicke's area (Montage C), and of Broca's area (Montage D), where for all montages A-D the "return" electrode was placed over the supraorbital contralateral forehead; bilateral stimulation with A-tDCS over the left Broca's and CtDCS over the right Broca's homologue (Montage E).

Results: In all cases, the "return" electrode over the contralesional supraorbital forehead was not inert and influenced the current path through the entire brain. Montage B, although similar to montage D in focusing the current in the perilesional area, exerted the greatest effect over the left perilesional cortex, which was even stronger in montage E.

Conclusions: The position and influence of both electrodes must be considered in the design and interpretation of tDCS clinical trials for aphasia.
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http://dx.doi.org/10.1016/j.brs.2015.06.018DOI Listing
July 2016

Combining TMS-EEG with transcranial direct current stimulation language treatment in aphasia.

Expert Rev Neurother 2015 ;15(7):833-45

IRCCS Fondazione Santa Lucia, Roma, Italy.

Despite the fact that different studies have been performed using transcranial direct current stimulation (tDCS) in aphasia, so far, to what extent the stimulation of a cerebral region may affect the activity of anatomically connected regions remains unclear. The authors used a combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to explore brain areas' excitability modulation before and after active and sham tDCS. Six chronic aphasics underwent 3 weeks of language training coupled with tDCS over the right inferior frontal gyrus. To measure the changes induced by tDCS, TMS-EEG closed to the area stimulated with tDCS were calculated. A significant improvement after tDCS stimulation was found which was accompained by a modification of the EEG over the stimulated region.
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http://dx.doi.org/10.1586/14737175.2015.1049998DOI Listing
March 2016

Combining Voxel-based Lesion-symptom Mapping (VLSM) With A-tDCS Language Treatment: Predicting Outcome of Recovery in Nonfluent Chronic Aphasia.

Brain Stimul 2015 Jul-Aug;8(4):769-76. Epub 2015 Jan 30.

IRCCS Fondazione Santa Lucia, Roma, Italy; Department of Studi Umanistici, University Federico II, Naples, Italy. Electronic address:

Background: Most of transcranial direct current stimulation (tDCS) studies in aphasia have already shown that significant changes in language performance could be improved by increased monitoring of the perilesional cortex in the left lesioned hemisphere with excitatory anodal tDCS (A-tDCS). However, no report to date has investigated which areas may be less predictable or may play a major role in the recovery from language impairment after brain stimulation.

Objective: We investigated the relationship between the localization of damage in the left hemisphere and the amount of language recovery after A-tDCS.

Methods: We conducted a Voxel-lesion mapping-symptom (VLSM) analysis on twenty non-fluent aphasics who underwent a language treatment in concomitance with left A-tDCS delivered over the left inferior frontal gyrus (IFG) and a sham condition. Significant changes in language performance before and after the two conditions were examined in three language tasks (picture description, noun and verb naming).

Results: VLSM analysis revealed that damage to distinct left hemispheric structures and, in particular, to the basal ganglia, the insula and the superior and inferior longitudinal fasciculi, resulted in lower responses to A-tDCS in all language measures.

Conclusions: Beneficial effects after A-tDCS over the left IFG depend on the anatomical integrity of different left subcortical structures among which are the white matter language pathways. Future studies combining different approaches on larger samples of subjects will further elucidate our understanding of how the human brain responds to tDCS.
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http://dx.doi.org/10.1016/j.brs.2015.01.413DOI Listing
February 2016

Bihemispheric tDCS enhances language recovery but does not alter BDNF levels in chronic aphasic patients.

Restor Neurol Neurosci 2014 ;32(2):367-79

IRCCS Fondazione Santa Lucia, Roma, Italy.

Purpose: Several studies have shown that transcranial direct current stimulation (tDCS) is a useful tool to enhance language recovery in aphasia. It has also been suggested that modulation of the neurotrophin brain-derived neurotrophic factor (BDNF) might be part of the mechanisms involved in tDCS effects on synaptic connectivity. However, all language studies have previously investigated the effects using unihemispheric stimulation. The purpose of the present study is to investigate the role of bihemispheric tDCS on language recovery and BDNF serum levels.

Methods: Seven aphasic persons underwent an intensive language therapy in two different conditions: real bihemispheric stimulation over the left and right Broca's areas and a sham condition.

Results: After the stimulation, patients exibited a significant recovery in three language tasks (picture description, noun and verb naming) compared to the sham condition which persisted in the follow-up session. No significant differences were found in BDNF serum levels after tDCS stimulation and in the follow-up session. However, a significant positive correlation was present for the real stimulation condition between percent changes in BDNF levels and in the verb naming task.

Conclusions: The data suggest that this novel approach may potentiate the recovery of language in chronic aphasia. They also emphasize the importance to further investigate the role of possible biomarkers associated with tDCS treatment response in language recovery.
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http://dx.doi.org/10.3233/RNN-130323DOI Listing
November 2014

Something to talk about: enhancement of linguistic cohesion through tdCS in chronic non fluent aphasia.

Neuropsychologia 2014 Jan 11;53:246-56. Epub 2013 Dec 11.

IRCCS Fondazione Santa Lucia, Roma, Italy; Dipartimento di Scienze Umane, Università di Udine, Udine, Italy. Electronic address:

Several studies have shown that the modulation of cortical activity through transcranial direct current stimulation (tDCS) enhances naming performance in persons with aphasia. In this study, we investigated the potential effects of tDCS in improving spontaneous speech and the ability to use connective words to establish cohesion among adjacent utterances in a group of eight participants with chronic non fluent aphasia. They were administered five short videoclips representing everyday life contexts and two picture description tasks. Three videoclips were used to elicit spontaneous conversation during the treatment, while the remaining tasks were presented to the patients only before and after the therapy. Patients were required to talk about each videoclip, with the help of a therapist, while they were treated with tDCS (20 min, 1 mA) over the left hemisphere in three different conditions: anodic tDCS over the Broca's area, anodic tDCS over the Wernicke's area and a sham condition. Each experimental condition was performed for ten consecutive daily sessions with 14 days of intersession interval. Only after Broca's stimulation, patients showed a greater improvement in producing words that enhanced the cohesion of their speech samples (i.e., pronouns, ellipses, word repetitions, conjunctions). Beneficial effects of the stimulation were generalized also to contexts presented to the patients at the beginning and at the end of the therapy sessions. Our data further confirm the key role of the left inferior frontal gyrus in binding words into a coherent speech. We believe that positive tDCS effects may be further extended to different linguistic domains, useful to promote language recovery.
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http://dx.doi.org/10.1016/j.neuropsychologia.2013.12.003DOI Listing
January 2014

Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy.

Expert Rev Neurother 2014 Jan 22;14(1):75-91. Epub 2013 Nov 22.

Dipartimento di Medicina Sperimentale e Clinica, Facoltà di Medicina, Ancona, Italy.

Aphasia is a highly disabling language disorder usually caused by a left-lateralized brain damage. Even if traditional linguistic-based therapies have been proved to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Therefore, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of non-invasive neurostimulation techniques to language rehabilitation has already provided promising results particularly for the recovery of word-retrieval deficits in chronic stroke aphasic patients. Positive outcomes also come from action observation therapy. Indeed, some very recent studies have shown that the observation and/or execution of gestures positively influences language recovery especially for words related to human actions. This article gives an overview of the most important results achieved using these two approaches and discusses how the application of these treatments might potentiate aphasia recovery.
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http://dx.doi.org/10.1586/14737175.2014.864555DOI Listing
January 2014

tDCS over the left inferior frontal cortex improves speech production in aphasia.

Front Hum Neurosci 2013 6;7:539. Epub 2013 Sep 6.

Facoltà di Medicina, Università Politecnica Marche Ancona, Italy ; Department of Clinical and Behavioural Neurology, Istituto di Ricovero a Carattere Scientifico Fondazione Santa Lucia Roma, Italy.

In this study, we investigated the combined effect of transcranial direct current stimulation (tDCS) and an intensive Conversational therapy treatment on discourse skills in 12 persons with chronic aphasia. Six short video clips depicting everyday life contexts were prepared. Three videoclips were used to elicit spontaneous conversation during treatment. The remaining three were presented only before and after the therapy. Participants were prompted to talk about the contents of each videoclip while stimulated with tDCS (20 min 1 mA) over the left hemisphere in three conditions: anodic tDCS over the Broca's area, anodic tDCS over the Wernicke's area, and a sham condition. Each experimental condition was performed for 10 consecutive daily sessions with 14 days of intersession interval. After stimulation over Broca's area, the participants produced more Content Units, verbs and sentences than in the remaining two conditions. Importantly, this improvement was still detectable 1 month after the end of treatment and its effects were generalized also to the three videoclips that had been administered at the beginning and at the end of the therapy sessions. In conclusion, anodic tDCS applied over the left Broca's area together with an intensive "Conversational Therapy" treatment improves informative speech in persons with chronic aphasia. We believe that positive tDCS effects may be further extended to other language domains, such as the recovery of speech production.
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http://dx.doi.org/10.3389/fnhum.2013.00539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764371PMC
September 2013

Bihemispheric stimulation over left and right inferior frontal region enhances recovery from apraxia of speech in chronic aphasia.

Eur J Neurosci 2013 Nov 11;38(9):3370-7. Epub 2013 Aug 11.

Facoltà di Medicina, Università Politecnica Marche, Via Tronto 10A, 60020, Ancona, Italy; IRCCS Fondazione Santa Lucia, Roma, Italy.

Several studies have already shown that transcranial direct current stimulation (tDCS) is a useful tool for enhancing recovery in aphasia. However, all tDCS studies have previously investigated the effects using unihemisperic stimulation. No reports to date have examined the role of bihemispheric tDCS on aphasia recovery. Here, eight aphasic persons with apraxia of speech underwent intensive language therapy in two different conditions: real bihemispheric anodic ipsilesional stimulation over the left Broca's area and cathodic contralesional stimulation over the right homologue of Broca's area, and a sham condition. In both conditions, patients underwent concurrent language therapy for their apraxia of speech. The language treatment lasted 10 days (Monday to Friday, then weekend off, then Monday to Friday). There was a 14-day intersession interval between the real and the sham conditions. In all patients, language measures were collected before (T0), at the end of (T10) and 1 week after the end of (F/U) treatment. Results showed that after simultaneous excitatory stimulation to the left frontal hemisphere and inhibitory stimulation to the right frontal hemisphere regions, patients exhibited a significant recovery not only in terms of better accuracy and speed in articulating the treated stimuli but also in other language tasks (picture description, noun and verb naming, word repetition, word reading) which persisted in the follow-up session. Taken together, these data suggest that bihemispheric anodic ipsilesional and cathodic contralesional stimulation in chronic aphasia patients may affect the treated function, resulting in a positive influence on different language tasks.
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http://dx.doi.org/10.1111/ejn.12332DOI Listing
November 2013

tDCS stimulation segregates words in the brain: evidence from aphasia.

Front Hum Neurosci 2013 14;7:269. Epub 2013 Jun 14.

Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia Roma, Italy.

A number of studies have already shown that modulating cortical activity by means of transcranial direct current stimulation (tDCS) improves noun or verb naming in aphasic patients. However, it is not yet clear whether these effects are equally obtained through stimulation over the frontal or the temporal regions. In the present study, the same group of aphasic subjects participated in two randomized double-blind experiments involving two intensive language treatments for their noun and verb retrieval difficulties. During each training, each subject was treated with tDCS (20 min, 1 mA) over the left hemisphere in three different conditions: anodic tDCS over the temporal areas, anodic tDCS over the frontal areas, and sham stimulation, while they performed a noun and an action naming tasks. Each experimental condition was run in five consecutive daily sessions over three weeks with 6 days of intersession interval. The order of administration of the two language trainings was randomly assigned to all patients. Overall, with respect to the other two conditions, results showed a significant greater improvement in noun naming after stimulation over the temporal region, while verb naming recovered significantly better after stimulation of the frontal region. These improvements persisted at one month after the end of each treatment suggesting a long-term effect on recovery of the patients' noun and verb difficulties. These data clearly suggest that the mechanisms of recovery for naming can be segregated coupling tDCS with an intensive language training.
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http://dx.doi.org/10.3389/fnhum.2013.00269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682157PMC
June 2013

How Conversational Therapy influences language recovery in chronic non-fluent aphasia.

Neuropsychol Rehabil 2013 4;23(5):715-31. Epub 2013 Jun 4.

a Facoltà di Medicina , Università Politecnica Marche , Ancona , Italy.

The study aimed to determine the efficacy of a Conversational Therapy approach in the treatment of chronic patients with moderately severe non-fluent aphasia. Eight patients completed a six week intensive language training. Every two weeks, each patient received rehabilitation using a different videoclip depicting everyday life. To elicit verbal communication, patients were required to observe each videoclip and to converse about it with the help of an experienced clinician. To measure any significant improvement in speech production all patients were tested before and after treatment. A significant increase in their ability to produce correct informative words (C-Units), verbs, nouns, adjectives, adverbs, as well as closed-class words (pronouns, articles and conjunctions) and well-formed sentences was found after therapy. Such improvement persisted at one week and one month after the end of the treatment. These results suggest that conversational therapy, applied through intensive language training, has a significant efficacy in the recovery of verbal communication in chronic non-fluent aphasic individuals. This approach should be considered for patients with moderately severe non-fluent aphasia, as it enhances not only the ability to use informative language but also its correct use in daily living.
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http://dx.doi.org/10.1080/09602011.2013.804847DOI Listing
April 2014