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A review of biological interventions in chronic aphasia
Annals of Indian Academy of Neurology ( IF 1.7 ) Pub Date : 2020-09-01 , DOI: 10.4103/aian.aian_549_20
E Susan Duncan, Aswathy Anakkathil Pradeep, Steven L Small


Aphasia is a common and debilitating condition following stroke. While the gold standard for aphasia treatment is behavioral speech-language therapy, benefits remain modest in chronic stages of recovery. This limitation motivates the pursuit of novel interventions for chronic aphasia. Here, we review biological approaches that have been used (or proposed for use, in the case of regenerative and genetic therapies) to treat chronic aphasia. These techniques aim to ameliorate the deficits of aphasia by directly manipulating brain function, rather than training lost or compensatory functions, although many have been used to augment effects of behavioral therapy. Specifically, we explore the most robust designs of transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and pharmacotherapy that have been applied in chronic (≥6 months) post-stroke aphasia. We also consider less investigated approaches including epidural cortical stimulation and photobiomodulation. All methods are currently in nascent phases and restricted to experimental studies and clinical trials. Although the evidence base remains limited, such interventions may ultimately improve language function and quality of life for those living with chronic aphasia. However, it is crucial that application of these methods consider the effects of concomitant speech-language therapy, as biological interventions combined with behaviorally induced experience-dependent plasticity will likely yield the most beneficial and durable outcomes.


中文翻译:

慢性失语症的生物干预综述


失语症是中风后常见的使人衰弱的疾病。虽然失语症治疗的金标准是行为言语治疗,但在慢性康复阶段,其益处仍然有限。这种局限性促使人们寻求针对慢性失语症的新型干预措施。在这里,我们回顾了已用于(或在再生和基因疗法的情况下建议用于治疗)慢性失语症的生物学方法。这些技术旨在通过直接操纵脑功能来改善失语症,而不是训练丧失或补偿的功能,尽管许多技术已被用来增强行为疗法的效果。具体来说,我们探索经颅磁刺激(TMS),经颅直流电刺激(tDCS)的最可靠设计,和药物疗法已应用于慢性(≥6个月)中风后失语症。我们还考虑较少研究的方法,包括硬膜外皮层刺激和光生物调节。目前,所有方法都处于起步阶段,并且仅限于实验研究和临床试验。尽管证据基础仍然有限,但此类干预措施最终可能会改善慢性失语症患者的语言功能和生活质量。然而,至关重要的是,这些方法的应用必须考虑伴随的言语治疗,因为生物干预结合行为诱导的经验依赖性可塑性可能会产生最有益和持久的结果。我们还考虑较少研究的方法,包括硬膜外皮层刺激和光生物调节。目前,所有方法都处于起步阶段,并且仅限于实验研究和临床试验。尽管证据基础仍然有限,但此类干预措施最终可能会改善慢性失语症患者的语言功能和生活质量。然而,至关重要的是,这些方法的应用必须考虑伴随的言语治疗,因为生物干预结合行为诱导的经验依赖性可塑性可能会产生最有益和持久的结果。我们还考虑较少研究的方法,包括硬膜外皮层刺激和光生物调节。目前,所有方法都处于起步阶段,并且仅限于实验研究和临床试验。尽管证据基础仍然有限,但此类干预措施最终可能会改善慢性失语症患者的语言功能和生活质量。然而,至关重要的是,这些方法的应用必须考虑伴随的言语治疗,因为生物干预结合行为诱导的经验依赖性可塑性可能会产生最有益和持久的结果。此类干预措施最终可以改善慢性失语症患者的语言功能和生活质量。然而,至关重要的是,这些方法的应用必须考虑伴随的言语治疗,因为生物干预结合行为诱导的经验依赖性可塑性可能会产生最有益和持久的结果。此类干预措施最终可以改善慢性失语症患者的语言功能和生活质量。然而,至关重要的是,这些方法的应用必须考虑伴随的言语治疗,因为生物干预结合行为诱导的经验依赖性可塑性可能会产生最有益和持久的结果。
更新日期:2020-10-06
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