Cerebellar stimulation for Aphasia Rehabilitation

小脑刺激用于失语康复

• 批准号: 10650819
• 负责人: Rajani Sebastian
• 金额: $ 48.98万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650819
• 关键词: Acceleration; Activities of Daily Living; Address; Adjuvant; Affect; Aftercare; Anodes; Anomia; Aphasia; Area; Award; Biological Markers; Brain; Cerebellum; Characteristics; Chronic; Cognitive; Communication; Communication Disability; Complication; Contralateral; Data; Diffusion Magnetic Resonance Imaging; Double-Blind Method; Effectiveness; Electrical Stimulation of the Brain; Exhibits; Functional Magnetic Resonance Imaging; Goals; Image; Impairment; Individual; Language; Language Therapy; Left; Lesion; Linguistics; Measures; Middle frontal gyrus structure; Mission; Motor Cortex; NIH Program Announcements; Names; National Institute on Deafness and Other Communication Disorders; Neuronal Plasticity; Neurons; Outcome; Painless; Participant; Pathway interactions; Patients; Persons; Phase; Phase II Clinical Trials; Philadelphia; Prevalence; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Residual state; Resolution; Rest; Retrieval; Semantics; Severities; Site; Source; Speech; Speech Therapy; Stroke; Structure; Techniques; Testing; Tissues; Treatment Effectiveness; Treatment Efficacy; Treatment outcome; United States; Work; aphasia rehabilitation; computerized; design; effectiveness evaluation; electric field; evidence base; improved; individual response; interest; lexical; neural; neuroregulation; noninvasive brain stimulation; novel; phase III trial; post stroke; predicting response; prevent; safety and feasibility; secondary outcome; semantic processing; skills; standard care; stroke patient; stroke-induced aphasia; structural imaging; transcranial direct current stimulation

Project Abstract Aphasia is a devastating complication of stroke. Speech and language treatment (SLT) can be helpful in restoring language function, but not all individuals show improvement. Recent studies indicate that Transcranial Direct Current Stimulation (tDCS) is a promising adjuvant approach to enhance the effectiveness of SLT. tDCS is a noninvasive, non-painful, electrical stimulation of the brain. It is believed that tDCS boosts neural plasticity that underlies recovery with SLT. A majority of the tDCS studies of aphasia have stimulated the left hemisphere regions. However, left hemisphere lesions common in post-stroke aphasia affect the electrical field in unpredictable ways, potentially preventing stimulation from reaching perilesional tissue associated with optimal recovery. Our work addressed this problem by stimulating a novel region, the right cerebellum. The right cerebellum is connected to the left hemisphere and involved in a variety of cognitive and language functions, including naming, which is often impaired in people with aphasia. The PI's prior work shows that cerebellar tDCS is safe, easily tolerated, and improved language skills in a number of stroke participants with aphasia. The proposed project will build on these findings by conducting a randomized, double-blind, sham-controlled, trial to determine the effectiveness of cathodal tDCS to the right cerebellum for the treatment of post-stroke aphasia. We will compare the effects of 15 sessions of cerebellar tDCS combined with an evidenced-based anomia treatment (semantic feature analysis, SFA) to 15 sessions of sham combined with SFA treatment in patients with chronic (at least 6 months post stroke) aphasia. We will evaluate the effects of cerebellar tDCS on naming untrained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. This project will also identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. Individual response to tDCS treatment is highly variable, and little is known about how factors related to imaging and linguistic characteristics combine to induce treatment responsiveness. We will carry out resting state functional magnetic resonance imaging (rsfMRI), diffusion tensor imaging (DTI), high resolution structural imaging, and detailed linguistic testing before the start of treatment to determine whether these factors can predict response to cerebellar tDCS and/or SFA. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent SLT for treatment of chronic aphasia.

项目摘要 失语症是中风的一种破坏性并发症。言语和语言治疗 (SLT) 有助于恢复 语言功能，但并非所有个体都表现出改善。最近的研究表明，经颅直接 电流刺激 (tDCS) 是一种很有前景的增强 SLT 有效性的辅助方法。经颅直流电刺激 (tDCS) 是 对大脑进行无创、无痛的电刺激。据信 tDCS 可以增强神经可塑性 是 SLT 恢复的基础。大多数失语症 tDCS 研究都刺激了左半球 地区。然而，中风后失语症中常见的左半球病变会影响电场 不可预测的方式，可能会阻止刺激到达与最佳相关的病灶周围组织 恢复。我们的工作通过刺激一个新的区域——右小脑来解决这个问题。右边的 小脑与左半球相连，参与多种认知和语言功能， 包括命名，而失语症患者的命名功能通常会受到损害。 PI 之前的工作表明小脑 tDCS 对于许多患有失语症的中风患者来说，它是安全的、易于耐受的，并且可以提高语言技能。这 拟议的项目将在这些发现的基础上进行一项随机、双盲、假对照试验 确定右侧小脑阴极 tDCS 治疗中风后失语症的有效性。 我们将比较 15 次小脑 tDCS 结合循证贫血的效果 治疗（语义特征分析，SFA）至 15 次假手术联合 SFA 治疗的患者 慢性（中风后至少 6 个月）失语。我们将评估小脑 tDCS 对命名的影响 未经训练的项目以及对功能性沟通、内容、效率和单词检索的影响 图片描述和生活质量。该项目还将识别成像和语言生物标志物，以确定 受益于小脑 tDCS 和 SFA 治疗的中风患者的特征。个人回应 经颅直流电刺激 (tDCS) 治疗的效果差异很大，而且对于与影像和语言相关的因素知之甚少。 特征结合起来诱导治疗反应。我们将进行静息态功能磁 磁共振成像 (rsfMRI)、扩散张量成像 (DTI)、高分辨率结构成像和详细 治疗开始前进行语言测试，以确定这些因素是否可以预测治疗反应 小脑 tDCS 和/或 SFA。本研究的长期目标是为 III 期随机试验提供基础 小脑 tDCS 与假手术联合 SLT 治疗慢性失语症的对照试验。

项目成果

Protocol for Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR): A randomized, double-blind, sham-controlled trial.

小脑刺激失语症康复方案 (CeSAR)：一项随机、双盲、假对照试验。

• DOI: 10.1101/2024.02.05.24302365
• 发表时间: 2024
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Lammers,Becky;Sydnor,MyraJ;Cust,Sarah;Kim,JiHyun;Yenokyan,Gayane;Hillis,ArgyeE;Sebastian,Rajani
• 通讯作者: Sebastian,Rajani