No effects of anodal transcranial direct stimulation on language abilities in early rehabilitation of post-stroke aphasic patients. Combined Transcranial Direct Current Stimulation and Robot-Assisted Arm Training in Subacute Stroke Patients Feasibility of using high-definition transcranial direct current stimulation (HD-tDCS) to enhance treatment outcomes in persons with aphasia. Transcranial direct current stimulation effects on neural processing in post‐stroke aphasia Aphasia in acute stroke: Incidence, determinants, and recovery Anodal transcranial direct current stimulation in early rehabilitation of patients with post-stroke non-fluent aphasia: a randomized, double-blind, sham-controlled pilot study. Using Transcranial Direct-Current Stimulation to Treat Stroke Patients With Aphasia Transcranial Direct Current Stimulation Improves Naming Reaction Time in Fluent Aphasia: A Double-Blind, Sham-Controlled Study Bihemispheric stimulation over left and right inferior frontal region enhances recovery from apraxia of speech in chronic aphasia. Non-Invasive Brain Stimulation Enhances the Effects of Melodic Intonation Therapy Electrical stimulation over the left inferior frontal gyrus (IFG) determines long-term effects in the recovery of speech apraxia in three chronic aphasics Short-Term Anomia Training and Electrical Brain Stimulation Transcranial Direct Current Stimulation Improves Word Retrieval in Healthy and Nonfluent Aphasic Subjects Improved picture naming in aphasia patients treated with cathodal tDCS to inhibit the right Broca's homologue area. How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain? Individualized treatment with transcranial direct current stimulation in patients with chronic non-fluent aphasia due to stroke tDCS stimulation segregates words in the brain: evidence from aphasia Improvement of the Working Memory and Naming by Transcranial Direct Current Stimulation Transcranial direct current stimulation in post-stroke sub-acute aphasia: study protocol for a randomized controlled trial Non-invasive repeated therapeutic stimulation for aphasia recovery: a multilingual, multicenter aphasia trial. Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke Cathodal transcranial direct current stimulation of the right Wernicke’s area improves comprehension in subacute stroke patients CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials [Long-term course of patients in neurological rehabilitation Phase B. Results of the 6-year follow-up in a multicenter study]. Impact of tDCS on cerebral autoregulation in aging and in patients with cerebrovascular diseases
BACKGROUND AND PURPOSE Recent research suggests that an increased level of stroke-affected left hemisphere cortical ( especially frontal ) excitability is associated with better language improvement in aphasic patients .  Anodal transcranial direct current stimulation ( A-tDCS ) , increasing cortical activity , may facilitate perilesional left hemisphere recruitment to subserve language processing and enhance effects of behavioural therapy . The aim of the study ( r and omized , double-blind , sham-controlled ) was to evaluate the effectiveness of repeated A-tDCS over Broca area as a strategy to enhance aphasia recovery during early post-stroke rehabilitation . MATERIAL AND METHODS Thirty-seven participants with moderate or severe aphasia were r and omized to receive 15 consecutive daily sessions of A-tDCS ( 1 mA , 10 min ; experimental group , n = 18 ) or sham stimulation ( 1 mA , 25 s ; control group , n = 19 ) followed by language therapy .  Effects of tDCS were assessed using the Boston Diagnostic Aphasia Examination , performed before and after the rehabilitation , and three months later . RESULTS The results did not confirm a positive impact of repeated A-tDCS , preceding language therapy , on language abilities in our patients . Although both groups improved after the therapy , there were no statistically significant differences between groups in either short-term or long-term tDCS effects . Effect sizes for the experimental group , at post-treatment and the 3-month follow-up , were slightly higher than in controls but insufficient to infer any beneficial influence of the applied intervention . CONCLUSIONS The findings do not support  A-tDCS functional benefits during early rehabilitation of post-stroke aphasia . Further research is needed to explore the effectiveness of this kind of neuromodulation Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population BACKGROUND Transcranial direct current stimulation ( tDCS ) enhances treatment outcomes  post-stroke .  Feasibility and tolerability of high-definition ( HD ) tDCS ( a technique that increases current focality and intensity ) for consecutive weekdays as an adjuvant to behavioral treatment in a clinical population has not been demonstrated . OBJECTIVE To determine HD-tDCS  feasibility outcomes : 1 ) ability to implement study as design ed , 2 ) acceptability of repeated HD-tDCS administration to patients , and 3 ) preliminary efficacy . METHODS Eight patients with chronic post-stroke aphasia participated in a r and omized crossover trial with two arms : conventional sponge-based ( CS ) tDCS and HD-tDCS . Computerized anomia treatment was administered for five consecutive days during each treatment arm . RESULTS Individualized modeling/targeting procedures and an 8-channel HD-tDCS device were developed . CS-tDCS and HD-tDCS were comparable in terms of implementation , acceptability , and outcomes . Naming accuracy and response time improved for both stimulation conditions . Change in accuracy of trained items was numerically higher ( but not statistically significant ) for HD-tDCS compared to CS-tDCS for most patients . CONCLUSIONS Regarding feasibility , HD-tDCS treatment studies can be implemented when design ed similarly to documented CS-tDCS studies . HD-tDCS is likely to be acceptable to patients and clinicians . Preliminary efficacy data suggest that HD-tDCS effects , using only 4 electrodes , are at least comparable to CS-tDCS Non‐invasive transcranial direct current stimulation ( tDCS ) can enhance recovery after stroke . However , fundamental knowledge about how tDCS impacts neural processing in the lesioned human brain is currently lacking . In the present study , it was investigated how tDCS modulates brain function in patients with post‐stroke language impairment ( aphasia ) . In a cross‐over , r and omized trial , patients named pictures of common objects during functional magnetic resonance imaging ( fMRI ) . Concurrently , excitatory ( anodal‐ ) or sham‐tDCS ( 1 mA , 20 min , or 30 s , respectively ) was administered to the left primary motor cortex , a montage with demonstrated potential to improve aphasic language . By choosing stimuli that could reliable be named by the patients , the authors aim ed to derive a pure measure of stimulation effects that was independent of treatment or performance effects and to assess how tDCS interacts with the patients ' residual language network . Univariate fMRI data analysis revealed reduced activity in domain‐general regions mediating high‐level cognitive control  during anodal‐tDCS . Independent component functional network analysis demonstrated selectively increased language network activity and an inter‐correlated shift from higher to lower frequency b and s , indicative of increased within‐network communication . Compared with healthy controls , anodal‐tDCS result ed in overall “ normalization ” of brain function in the patients . These results demonstrate for the first time how tDCS modulates neural processing in stroke patients . Such information is crucial to assure that behavioral treatments targeting specific neural circuits overlap with regions that are modulated by tDCS , thereby maximizing stimulation effects during therapy . Hum Brain Mapp 38:1518–1531 , 2017 . © 2016 Wiley Periodicals , Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language . We studied prospect ively and consecutively an unselected and community‐based sample of 881 patients with acute stroke .  Assessment of aphasia  was done at admission , weekly during the hospital stay , and at a 6‐months follow‐up using the aphasia score of the Sc and inavian Stroke Scale .  Thirty‐eight percent had aphasia at the time of admission ; at discharge 18 % had aphasia .  Sex was not a determinant of aphasia in stroke , and no sex difference in the anterior‐posterior distribution of lesions was found . The remission curve was steep : Stationary language function in 95 % was reached within 2 weeks in those with initial mild aphasia , within 6 weeks in those with moderate , and within 10 weeks in those with severe aphasia . A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia . Initial severity of aphasia was the only clinical ly relevant predictor of aphasia outcome . Sex , h and edness , and side of stroke lesion were not independent outcome predictors , and the influence of age was minimal PURPOSE Recent research in patients with chronic aphasia shows an association between excitatory anodal transcranial direct current stimulation ( A-tDCS ) of the stroke-affected left hemisphere coupled with speech and language therapy ( SLT ) and better language performance . The present study aim ed to investigate this association during the early post-stroke rehabilitation period , when adaptive changes are most possible on neurophysiological and behavioral levels . METHODS We r and omized 24 patients with non-fluent aphasia to receive 15 consecutive sessions ( 5 days/week for 3 weeks ) of A-tDCS ( 1 mA , 10 min ; n = 14 ) or sham tDCS ( S-tDCS : 1 mA , 25 sec ; n = 10 ) over Broca 's area followed by 45-min SLT . Naming ability was assessed before the rehabilitation , after its completion , and three months later . RESULTS Both groups significantly improved after the therapy . There were no statistically significant between-group differences in the short-term or long-term tDCS effects on naming accuracy and naming time . The A-tDCS group obtained higher effect sizes in naming time , both post-treatment and at the 3-month follow-up , suggesting potential benefits of the stimulation . CONCLUSIONS The findings provide only weak evidence for A-tDCS-related language gains during early neurorehabilitation of post-stroke aphasia . Further research is needed to explore the effectiveness of this kind of neuromodulation Background and Purpose — Recent research suggests that increased left hemisphere cortical activity , primarily of the left frontal cortex , is associated with improved naming performance in stroke patients with aphasia . Our aim was to determine whether anodal transcranial direct-current stimulation ( tDCS ) , a method thought to increase cortical excitability , would improve naming accuracy in stroke patients with aphasia when applied to the scalp overlying the left frontal cortex . Methods — Ten patients with chronic stroke-induced aphasia received 5 days of anodal tDCS ( 1 mA for 20 minutes ) and 5 days of sham tDCS ( for 20 minutes , order r and omized ) while performing a computerized anomia treatment . tDCS positioning was guided by a priori functional magnetic resonance imaging results for each individual during an overt naming task to ensure that the active electrode was placed over structurally intact cortex . Results — Results revealed significantly improved naming accuracy of treated items ( F[1,9]=5.72 , P<0.040 ) after anodal tDCS compared with sham tDCS . Patients who demonstrated the most improvement were those with perilesional areas closest to the stimulation site . Crucially , this treatment effect persisted at least 1 week after treatment . Conclusions — Our findings suggest that anodal tDCS over the left frontal cortex can lead to enhanced naming accuracy in stroke patients with aphasia and , if proved to be effective in larger studies , may provide a supplementary treatment approach for anomia Background and Purpose — Previous evidence suggests that anodal transcranial direct current stimulation ( A-tDCS ) applied to the left hemisphere can improve aphasic participants ' ability to name common objects . The current study further examined this issue in a more tightly controlled experiment in participants with fluent aphasia . Methods — We examined the effect of A-tDCS on reaction time during overt picture naming in 8 chronic stroke participants . Anode electrode placement targeted perilesional brain regions that showed the greatest activation on a pretreatment functional MRI scan administered during overt picture naming with the reference cathode electrode placed on the contralateral forehead . A-tDCS ( 1 mA ; 20-minute ) was compared with sham tDCS ( S-tDCS ) in a crossover design . Participants received 10 sessions of computerized anomia treatment ; 5 sessions included A-tDCS and 5 included S-tDCS . Results — Coupling A-tDCS with behavioral language treatment reduced reaction time during naming of trained items immediately posttreatment ( Z=1.96 , P=0.025 ) and at subsequent testing 3 weeks later ( Z=2.52 , P=0.006 ) . Conclusions — A-tDCS administered during language treatment decreased processing time during picture naming by fluent aphasic participants . Additional studies combining A-tDCS , an inexpensive method with no reported serious side effects , with behavioral language therapy are recommended 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 , result ing in a positive influence on different language tasks Research has suggested that a fronto-temporal network in the right hemisphere may be responsible for mediating melodic intonation therapy ’s ( MIT ) positive effects on speech recovery . We investigated the potential for a non-invasive brain stimulation technique , transcranial direct current stimulation ( tDCS ) , to augment the benefits of MIT in patients with non-fluent aphasia by modulating neural activity in the brain during treatment with MIT . The polarity of the current applied to the scalp determines the effects of tDCS on the underlying tissue : anodal-tDCS increases excitability , whereas cathodal tDCS decreases excitability . We applied anodal-tDCS to the posterior inferior frontal gyrus of the right hemisphere , an area that has been shown both to contribute to singing through the mapping of sounds to articulatory actions and to serve as a key region in the process of recovery from aphasia , particularly in patients with large left hemisphere lesions . The stimulation was applied while patients were treated with MIT by a trained therapist . Six patients with moderate to severe non-fluent aphasia underwent three consecutive days of anodal-tDCS + MIT , and an equivalent series of sham-tDCS + MIT . The two treatment series were separated by 1 week , and the order in which the treatments were administered was r and omized . Compared to the effects of sham-tDCS + MIT , anodal-tDCS + MIT led to significant improvements in fluency of speech . These results support the hypothesis that , as the brain seeks to reorganize and compensate for damage to left hemisphere language centers , combining anodal-tDCS with MIT may further recovery from post-stroke aphasia by enhancing activity in a right hemisphere sensorimotor network for articulation A number of studies have shown that modulating cortical activity by means of transcranial direct current stimulation ( tDCS ) affects the performance of both healthy and brain-damaged subjects . In this study , we investigated the potential of tDCS for the recovery of apraxia of speech in 3 patients with stroke-induced aphasia . Over 2 weeks , three aphasic subjects participated in a r and omized double-blinded experiment involving intensive language training for their articulatory difficulties in two tDCS conditions . Each subject participated in five consecutive daily sessions of anodic tDCS ( 20 min , 1 mA ) and sham stimulation over the left inferior frontal gyrus ( referred to as Broca 's area ) while they performed a repetition task . By the end of each week , a significant improvement was found in both conditions . However , all three subjects showed greater response accuracy in the anodic than in the sham condition . Moreover , results for transfer of treatment effects , although different across subjects , indicate a generalization of the recovery at the language test . Subjects 2 and 3 showed a significant improvement in oral production tasks , such as word repetition and reading , while Subjects 1 and 2 had an unexpected significant recovery in written naming and word writing under dictation tasks . At three follow-ups ( 1 week , 1 and 2 months after the end of treatment ) , response accuracy was still significantly better in the anodic than in sham condition , suggesting a long-term effect on the recovery of their articulatory gestures Background and Purpose — Language training success in chronic aphasia remains only moderate . Electric brain stimulation may be a viable way to enhance treatment efficacy . Methods — In a r and omized , double-blind , sham-controlled crossover trial , we assessed if anodal transcranial direct current stimulation compared to cathodal transcranial direct current stimulation and sham stimulation over the right temporo-parietal cortex would improve the success of short-term high-frequency anomia training . Twelve chronic poststroke aphasia patients were studied .  Naming outcome was assessed after training and 2 weeks later . Results — All training conditions led to a significant increase in naming ability , which was retained for at least 2 weeks after the end of the training . Application of anodal transcranial direct current stimulation significantly enhanced the overall training effect compared to sham stimulation . Baseline naming ability significantly predicted anodal transcranial direct current stimulation effects . Conclusions — Anodal transcranial direct current stimulation applied over the non language dominant hemisphere can enhance language training outcome in chronic aphasia . Clinical Trial Registration — URL : www . clinical trials.gov/. Unique identifier : NCT00822068 A number of studies have shown that modulating cortical activity by means of transcranial direct current stimulation ( tDCS ) affects performances of both healthy and brain-damaged subjects . In this study , we investigated the potential of tDCS to enhance associative verbal learning in 10 healthy individuals and to improve word retrieval deficits in three patients with stroke-induced aphasia . In healthy individuals , tDCS ( 20 min , 1 mA ) was applied over Wernicke 's area ( position CP5 of the International 10–20 EEG System ) while they learned 20 new “ words ” ( legal nonwords arbitrarily assigned to 20 different pictures ) . The healthy subjects participated in a r and omized counterbalanced double-blind procedure in which they were subjected to one session of anodic tDCS over left Wernicke 's area , one sham session over this location and one session of anodic tDCS stimulating the right occipito-parietal area . Each experimental session was performed during a different week ( over three consecutive weeks ) with 6 days of intersession interval . Over 2 weeks , three aphasic subjects participated in a r and omized double-blind experiment involving intensive language training for their anomic difficulties in two tDCS conditions . Each subject participated in five consecutive daily sessions of anodic tDCS ( 20 min , 1 mA ) and sham stimulation over Wernicke 's area while they performed a picture-naming task . By the end of each week , anodic tDCS had significantly improved their accuracy on the picture-naming task . Both normal subjects and aphasic patients also had shorter naming latencies during anodic tDCS than during sham condition . At two follow-ups ( 1 and 3 weeks after the end of treatment ) , performed only in two aphasic subjects , response accuracy and reaction times were still significantly better in the anodic than in the sham condition , suggesting a long-term effect on recovery of their anomic disturbances PURPOSE Previous reports have suggested that noninvasive cortical stimulation could influence speech production in patients with chronic stroke . Here , we evaluated the hypothesis that cathodal transcranial DC stimulation ( ctDCS ) , a technique that decreases excitability of stimulated cortical sites , applied over a healthy right Broca 's homologue area could improve picture naming in patients with post-stroke aphasia . METHODS Ten right-h and ed patients with post-stroke aphasia were enrolled in this double blind , counterbalanced sham-controlled , crossover study . Each patient received an intervention of ctDCS ( 2 mA for 20 min ) and of sham tDCS ( 2 mA for 1 min ) daily for 5 consecutive days in a r and omized crossover manner with a minimum interval of one week between interventions , over a healthy right Broca 's homologue area using a left supraorbital anode and simultaneous daily sessions of conventional word-retrieval training . The primary endpoint measure of this study was a st and ardized , vali date d Korean version of the Boston Naming Test , which is a measure of picture naming skills . RESULTS ctDCS was not found to have any adverse effects . Furthermore , significantly improved picture naming ( p = 0.02 ) was observed at 1 hour following the last ( 5th ) ctDCS treatment session , but no changes were observed after sham tDCS . CONCLUSION These results demonstrate that cathodal tDCS over the right healthy Broca 's homologue area with a left supraorbital anodal location can improve picture naming task performance in post-stroke aphasia Transcranial direct current stimulation ( tDCS ) of the primary motor h and area ( M1 ) can produce lasting polarity-specific effects on corticospinal excitability and motor learning in humans . In 16 healthy volunteers , O positron emission tomography ( PET ) of regional cerebral blood flow ( rCBF ) at rest and during finger movements was used to map lasting changes in regional synaptic activity following 10 min of tDCS ( + /-1 mA ) . Bipolar tDCS was given through electrodes placed over the left M1 and right frontopolar cortex . Eight subjects received anodal or cathodal tDCS  of the left M1 , respectively . When compared to sham tDCS , anodal and cathodal tDCS induced widespread increases and decreases in rCBF in cortical and subcortical areas . These changes in rCBF were of the same magnitude as task-related rCBF changes during finger movements and remained stable throughout the 50-min period of PET scanning . Relative increases in rCBF after real tDCS compared to sham tDCS were found in the left M1 , right frontal pole , right primary sensorimotor cortex and posterior brain regions irrespective of polarity . With the exception of some posterior and ventral areas , anodal tDCS increased rCBF in many cortical and subcortical regions compared to cathodal tDCS . Only the left dorsal premotor cortex demonstrated an increase in movement related activity after cathodal tDCS , however , modest compared with the relatively strong movement-independent effects of tDCS . Otherwise , movement related activity was unaffected by tDCS . Our results indicate that tDCS is an effective means of provoking sustained and widespread changes in regional neuronal activity . The extensive spatial and temporal effects of tDCS need to be taken into account when tDCS is used to modify brain function While evidence suggests that transcranial direct current stimulation ( tDCS ) may facilitate language recovery in chronic post-stroke aphasia , individual variability in patient response to different patterns of stimulation remains largely unexplored . We sought to characterize this variability among chronic aphasic individuals , and to explore whether repeated stimulation with an individualized optimal montage could lead to persistent reduction of aphasia severity . In a two-phase study , we first stimulated patients with four active montages ( left hemispheric anode or cathode ; right hemispheric anode or cathode ) and one sham montage ( Phase 1 ) . We examined changes in picture naming ability to address ( 1 ) variability in response to different montages among our patients , and ( 2 ) whether individual patients responded optimally to at least one montage . During Phase 2 , subjects who responded in Phase 1 were r and omized to receive either real-tDCS or to receive sham stimulation ( 10 days ) ; patients who were r and omized to receive sham stimulation first were then crossed over to receive real-tDCS ( 10 days ) . In both phases , 2 mA tDCS was administered for 20 min per real-tDCS sessions and patients performed a picture naming task during stimulation . Patients ' language ability was re-tested after 2-weeks and 2-months following real and sham tDCS in Phase 2 . In Phase 1 , despite considerable individual variability , the greatest average improvement was observed after left-cathodal stimulation . Seven out of 12 subjects responded optimally to at least one montage as demonstrated by transient improvement in picture-naming . In Phase 2 , aphasia severity improved at 2-weeks and 2-months following real-tDCS but not sham . Despite individual variability with respect to optimal tDCS approach , certain montages result in consistent transient improvement in persons with chronic post-stroke aphasia . This preliminary study supports the notion that individualized tDCS treatment may enhance aphasia recovery in a persistent manner 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 r and omized 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 r and omly 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 Objective To investigate the effects of transcranial direct current stimulation ( tDCS ) applied over the prefrontal cortex on the improvement of verbal , visuospatial working memory and naming in healthy adults . Method Thirty two healthy adults ( 15 males and 17 females , mean age 37.3±13.0 years ) were enrolled in this study . The subjects were divided into four groups r and omly . They underwent sham or anodal tDCS over the left or right prefrontal cortex , for 20 minutes at a direct current of 1 mA. Before and immediately after tDCS , the subjects performed the Korean version of the mini-mental state exam ( K-MMSE ) and stroop test ( color/word/interference ) for the screening of cognitive function . For working memory and language evaluation , the digit span test ( forward/backward ) , the visuospatial attention test in computer assisted cognitive program ( CogPack ® ) and the Korean-Boston Naming Test ( K-BNT ) were assessed before tDCS , immediately after tDCS , and 2 weeks after tDCS . Results The stroop test ( word/interference ) , backward digit span test and K-BNT were improved in the left prefrontal tDCS group compared with that of the sham group ( p<0.05 ) . The stroop test ( interference ) and visuospatial attention test were in the right prefrontal tDCS group compared with that of the sham group ( p<0.05 ) . Their improvement lasted for 2 weeks after stimulation . Conclusion tDCS can induce verbal working memory improvement and naming facilitation by stimulating the left prefrontal cortex . It can also improve the visuospatial working memory by stimulating the right prefrontal cortex . Further studies which are lesion and symptom specific tDCS treatment for rehabilitation of stroke can be carried out Background Transcranial direct current stimulation ( tDCS ) is a promising new technique to optimize the effect of regular Speech and Language Therapy ( SLT ) in the context of aphasia rehabilitation . The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke . The primary aim is to evaluate the potential effect of tDCS on language functioning , specifically on word-finding , as well as generalization effects to verbal communication . The secondary aim is to evaluate its effect on social participation and quality of life , and its cost-effectiveness . Methods We strive to include 58 stroke patients with aphasia , enrolled in an inpatient or outpatient stroke rehabilitation program , in a multicenter , double-blind , r and omized controlled trial with two parallel groups and 6 months ’ follow-up . Patients will participate in two separate intervention weeks , with a pause of 2 weeks in between , in the context of their regular aphasia rehabilitation program . The two intervention weeks comprise daily 45-minute sessions of word-finding therapy , combined with either anodal tDCS over the left inferior frontal gyrus ( 1 mA , 20 minutes ; experimental condition ) or sham-tDCS over the same region ( control condition ) . The primary outcome measure is word-finding . Secondary outcome measures are verbal communication , social participation , quality of life , and cost-effectiveness of the intervention . Discussion Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness . Trial registration Nederl and s Trail Register : NTR4364 . Registered on 21 February 2014 Noninvasive brain stimulation such as repetitive transcranial magnetic stimulation ( rTMS ) or transcranial direct current stimulation ( tDCS ) has been used in case series and small r and omized controlled trials to improve recovery from poststroke aphasia in combination with speech and language therapy . Results of these studies suggest possible clinical efficacy and an excellent safety profile . Therefore , a larger international multicenter proof-of-concept trial was launched , to directly compare the safety and efficacy of rTMS , tDCS , and sham stimulation as adjuvant therapy to speech and language therapy in subacute poststroke aphasia . In the 4 participating centers , subacute stroke patients with aphasia are r and omized between 5 and 30 days after ischemic stroke to either receive rTMS , tDCS , or sham stimulation in combination with a daily 45 minutes speech and language therapy session for 10 days . Efficacy is evaluated at 1 and 30 days after the last of the 10 treatment sessions using 3 outcome measures , vali date d in all participating language s : Boston naming test , Token test , and verbal fluency test . Additionally , adverse events are recorded to prove safety . In this study , a total of 90 patients will be recruited , and data analysis will be completed in 2016 . This is the first multilingual and multinational r and omized and controlled trial in poststroke aphasia and if positive , will add an effective new strategy for early stage poststroke aphasia rehabilitation Aphasia , depression , and cognitive dysfunction are common consequences of stroke , but knowledge of their interrelationship is limited . This 1-year prospect i ve study was design ed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric , neurological , and cognitive correlates . We studied a series of 106 consecutive patients ( 46 women and 60 men , mean age 65.8 years ) with first-ever ischaemic brain infa rct ion . The patients were clinical ly examined , and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later . Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke . Aphasia was diagnosed in 34 % of the patients during the acute phase , and two thirds of them remained so 12 months later . Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62 % 12 months after stroke . The prevalence of major depression increased from 11 to 33 % during the 12-month follow-up period . The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia . One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits . Although the prevalence of depression in aphasic patients decreases in the long term , the proportion of patients suffering from major depression seems to increase . We emphasize the importance of the multidimensional evaluation of aphasic stroke patients Previous studies have shown the appearance of right-sided language -related brain activity in right-h and ed patients after a stroke .  Non-invasive brain stimulation such as transcranial direct current stimulation ( tDCS ) and repetitive transcranial magnetic stimulation ( rTMS ) have been shown to modulate excitability in the brain . Moreover , rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients . Here , we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke . We hypothesized that tDCS applied to the left superior temporal gyrus ( Wernicke 's area ) or the right Wernicke 's area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke . Participants included right-h and ed subacute stroke patients with global aphasia due to ischemic infa rct of the left M1 or M2 middle cerebral artery . Patients were r and omly divided into three groups : patients who received anodal tDCS applied to the left superior temporal gyrus , patients who received cathodal tDCS applied to the right superior temporal gyrus , and patients who received sham tDCS . All patients received conventional speech and language therapy during each period of tDCS application . The Korean-Western Aphasia Battery ( K-WAB ) was used to assess all patients before and after tDCS sessions . After intervention , all patients had significant improvements in aphasia quotients , spontaneous speech , and auditory verbal comprehension . However , auditory verbal comprehension improved significantly more in patients treated with a cathode , as compared to patients in the other groups . These results are consistent with the role of Wernicke 's area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke , suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating Transcranial direct current stimulation has shown promise to improve recovery in patients with post-stroke aphasia , but previous studies have only assessed stimulation effects on impairment parameters , and evidence for long-term maintenance of transcranial direct current stimulation effects from r and omized , controlled trials is lacking . Moreover , due to the variability of lesions and functional language network reorganization after stroke , recent studies have used advanced functional imaging or current modelling to determine optimal stimulation sites in individual patients . However , such approaches are expensive , time consuming and may not be feasible outside of specialized research centres , which complicates incorporation of transcranial direct current stimulation in day-to-day clinical practice . Stimulation of an ancillary system that is functionally connected to the residual language network , namely the primary motor system , would be more easily applicable , but effectiveness of such an approach has not been explored systematic ally . We conducted a r and omized , parallel group , sham-controlled , double-blind clinical trial and 26 patients with chronic aphasia received a highly intensive naming therapy over 2 weeks ( 8 days , 2 × 1.5 h/day ) . Concurrently , anodal-transcranial direct current stimulation was administered to the left primary motor cortex twice daily at the beginning of each training session . Naming ability for trained items ( n = 60 pictures that could not be named during repeated baseline assessment s ) , transfer to untrained items ( n = 284 pictures ) and generalization to everyday communication were assessed immediately post-intervention and 6 months later . Naming ability for trained items was significantly improved immediately after the end of the intervention in both the anodal ( Cohen 's d = 3.67 ) and sham-transcranial direct current stimulation groups ( d = 2.10 ) , with a trend for larger gains in the anodal-transcranial direct current stimulation group ( d = 0.71 ) . Treatment effects for trained items were significantly better maintained in the anodal-transcranial direct current stimulation group 6 months later ( d = 1.19 ) . Transfer to untrained items was significantly larger in the anodal-transcranial direct current stimulation group after the training ( d = 1.49 ) and during the 6 month follow-up assessment ( d = 3.12 ) . Transfer effects were only maintained in the anodal-transcranial direct current stimulation group . Functional communication was significantly more improved in the anodal-transcranial direct current stimulation group at both time points compared to patients treated with sham-transcranial direct current stimulation ( d = 0.75 - 0.99 ) . Our results provide the first evidence from a r and omized , controlled trial that transcranial direct current stimulation can improve both function and activity-related outcomes in chronic aphasia , with medium to large effect sizes , and that these effects are maintained over extended periods of time . These effects were achieved with an easy-to-implement and thus clinical ly feasible motor-cortex montage that may represent a promising ' backdoor ' approach to improve language recovery after stroke The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials BACKGROUND After conclusion of emergency care for severe neurological diseases patients in Germany are admitted at an early stage to so-called Phase B rehabilitation . No studies have been carried out on the long-term course of these patients . PATIENTS AND METHODS In a prospect i ve study in 2002 patients in Phase B from 9 centers were included and follow-up investigations were carried out after 5 and 6 years . Assessment instruments used were the Barthel index , the Rankin scale and the EQ-5D . Factors for the risk of a poor outcome and the chances for a good outcome were evaluated using multivariate logistic regression . RESULTS A total of 1,280 patients were included in the study . A high age increased the risk of dying with a hazard quotient ( HQ ) of 1.05 ( 95 % CI : 1.04 - 1.06 ) and high point counts in the coma remission scale ( HQ 0.93 ; 95 % CI : 0.92 - 0.96 ) and Barthel index ( HQ 0.97 ; 95 % CI : 0.97 - 0.98 ) on discharge reduced the risk of dying after 5 years . The factors swallowing impairment ( OR 3.1 ; 95 % CI : 1.7 - 5.5 ) and obligatory surveillance at the end of rehabilitation ( OR 3.2 ; 95 % CI : 1.2 - 8.6 ) increased the risk of a poor result in the Rankin scale 2 - 4 and the factors communication disorder ( OR 5.0 ; 95 % CI : 2.0 - 12.8 ) and PEG ( percutaneous endoscopic gastrostomy ) ( OR 19.7 ; 95 % CI : 2.7 - 144.4 ) on discharge increased the risk of a reduced health-related quality of life ( defined as EQ-5D VAS < 70 ) after 6 years . CONCLUSIONS If support for bodily functions can be successfully reduced during Phase B rehabilitation , the patients will have a good outcome with respect to 5-year survival . If this is not successful the outcome is unfavorable with respect to survival and with respect to achieving self-sufficiency and health-related quality of life after 6 years Following seminal articles on the technique and underlying mechanisms of transcranial direct current stimulation ( tDCS ) at the turn of this century,1 tDCS has gained special attention in neurorehabilitative research , given its ability to modulate brain function in a polarity-specific manner in stroke patients together with an excellent safety profile.2 However , an important safety concern emerged recently with regard to its impact on cerebral autoregulation , given a report on decreased autoregulation after 15 minutes anodal tDCS ( atDCS ) over primary motor cortex ( M1 ) in young healthy subjects.3  Cerebral autoregulation , assessed by vasomotor reactivity ( VMR ) , reflects the autonomic ability of cerebral arterioles to dilate following a vasodilatory stimulus . It is consistently decreased in patients with cerebrovascular diseases,4 and has been linked to stroke risk.5 Thus , a decrease of VMR after atDCS may be harmful to patients with already impaired VMR , such as stroke patients .4 Importantly , > 40 ongoing trials with stroke patients and atDCS  are registered on www . clinical trials.gov as of May 2014 . Thus , the concerns raised by Vernieri et al.3 may carry important clinical implication
BACKGROUND Stroke is one of the leading causes of disability worldwide and aphasia among survivors is common .
Current speech and language therapy ( SLT ) strategies have only limited effectiveness in improving aphasia .
A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation ( tDCS ) to modulate cortical excitability and hence to improve aphasia .
OBJECTIVES To assess the effects of tDCS for improving aphasia in people who have had a stroke .