ABSTRACT

Background: Intermittent theta burst stimulation (iTBS) administered to the left dorsolateral prefrontal cortex (LDLPFC) has been shown to advance working memory (WM) abilities. At the same time, WM training is widely used to enhance learning associated with low language skills. An emerging area of research is that of applying cortical stimulation as an adjunct to behavioural therapy to improve language abilities in people with aphasia (PWA) after stroke.

Aim: The aim of this study was to pilot the efficacy of the iTBS protocol, targeting the LDLPFC in combination with computerized WM training by measuring the near-transfer effects on WM and fluid intelligence (Gf) and far-transfer effects on language functioning and quality of life (QoL) in an individual with stroke-induced chronic aphasia.

Methods & Procedures: The participant was a 31-year old female who presented with chronic non-fluent aphasia, following a left-hemisphere stroke involving the left frontoparietal lobes. She showed prominent anomia with frequent occurrences of word-finding difficulties.

The assessment battery included a screening measure of WM, a standardized aphasia battery, a non-verbal intelligence test, spontaneous speech samples, a procedural discourse task, and a questionnaire addressing quality of life. All measures were administered once at baseline, immediately after treatment was terminated, and once during follow-up testing, at 3 months post-treatment. The treatment program included 10 consecutive daily sessions of 30-minutes computer-assisted WM training preceded by 3-minutes of iTBS.

Outcomes & Results: Statistically significant improvement from baseline to post-treatment was found only for the non-verbal intelligence measure, suggesting near-transfer effects. There was no improvement on the computerized WM screening measure. Although no other measures revealed a statistically significant difference, there was a trend towards better performance on untreated items of receptive and expressive language tasks (far-transfer).

Conclusions: The findings revealed a trend for improvement in receptive and expressive language abilities in one individual with chronic aphasia. The iTBS protocol in combination with computerised WM training could be a promising treatment but further studies with larger number of participants are needed to establish its effectiveness for improvement of aphasia after stroke.

摘要

背景：对左侧背外侧前额叶皮层 (LDLPFC) 进行间歇性 theta 爆发刺激 (iTBS) 已被证明可以提高工作记忆 (WM) 能力。同时，WM 培训被广泛用于增强与低语言技能相关的学习。一个新兴的研究领域是应用皮质刺激作为行为疗法的辅助手段，以提高中风后失语症 (PWA) 患者的语言能力。

目的：本研究的目的是通过测量对 WM 和流体智力 ( Gf ) 的近转移效应以及对语言功能和中风引起的慢性失语症患者的生活质量 (QoL)。

方法和程序：参与者是一名 31 岁的女性，在涉及左额顶叶的左半球中风后出现慢性非流畅性失语症。她表现出明显的失常症，经常出现找词困难。

评估组包括 WM 筛查措施、标准化失语症组、非语言智力测试、自发性语音样本、程序性话语任务和关于生活质量的问卷。所有措施均在基线时、治疗结束后立即实施一次，以及在随访测试期间、治疗后 3 个月时实施一次。治疗计划包括连续 10 天的 30 分钟计算机辅助 WM 培训，然后是 3 分钟的 iTBS。

结果和结果：仅在非语言智力测量方面发现从基线到治疗后的统计学显着改善，表明接近转移效应。计算机化 WM 筛查措施没有改进。尽管没有其他措施显示出统计学上的显着差异，但在接受性和表达性语言任务（远迁移）的未处理项目上有更好的表现的趋势。

结论：研究结果揭示了一名慢性失语症患者的接受和表达语言能力有改善的趋势。iTBS 协议与计算机化 WM 培训相结合可能是一种很有前途的治疗方法，但需要更多参与者的进一步研究来确定其改善中风后失语症的有效性。