Aphasia Neuroplasticity Review

Weiduschat et al. (2011)

Reference

AuthorsWeiduschat N, Thiel A, Rubi-Fessen I, Hartmann A, Kessler J, Merl P, Kracht L, Rommel T, Heiss WD
TitleEffects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study
ReferenceStroke 2011; 42: 409-415
PMID21164121
DOI10.1161/strokeaha.110.597864

Participants

LanguageGerman
Inclusion criteriaAge 55-85
Number of individuals with aphasia10 (plus 4 excluded: 3 malfunction of TMS device or claustrophobia; 1 recovered nearly completely prior to intervention)
Number of control participants0
Were any of the participants included in any previous studies?No
Is age reported for patients and controls, and matched?Yes (range 59-83 years)
Is sex reported for patients and controls, and matched?Yes (males: 5; females: 5)
Is handedness reported for patients and controls, and matched?Yes (right: 10; left: 0)
Is time post stroke onset reported and appropriate to the study design?Yes (range 18-97 days; patients at different subacute stages of recovery)
To what extent is the nature of aphasia characterized?Type only
Language evaluationAAT
Aphasia severityT1: TT range 0-45 errors; T2: TT range 0-44 errors
Aphasia typeT1: 5 Wernicke's, 2 Broca's, 2 global, 1 amnestic fluent; T2: not stated
First stroke only?Yes
Stroke typeNot stated
To what extent is the lesion distribution characterized?Extent and location
Lesion extentRange 0.7-88.9 cc
Lesion locationL MCA
Participants notes

Imaging

ModalityPET (rCBF)
Is the study cross-sectional or longitudinal?Longitudinal—mixed
If longitudinal, at what time point(s) were imaging data acquired?T1: pre-treatment/subacute (range 18-97 days post onset); T2: post-treatment, ~2 weeks later
If longitudinal, was there any intervention between the time points?Individualized SLT, 45 minutes/day, 5 days/week, 2 weeks; 6 patients underwent rTMS to the R IFG pars triangularis; 4 received vertex (sham) rTMS
Is the scanner described?Yes (CTI-Siemens ECAT EXACT HR)
Is the timing of stimulus presentation and image acquisition clearly described and appropriate?Yes
Design typePET
Total images acquired8
Are the imaging acquisition parameters, including coverage, adequately described and appropriate?Yes (whole brain)
Is preprocessing and intrasubject coregistration adequately described and appropriate?Yes
Is first level model fitting adequately described and appropriate?Yes
Is intersubject normalization adequately described and appropriate?Yes
Imaging notes

Conditions

Are the conditions clearly described?Yes
ConditionResponse typeRepetitionsAll groups could do?All individuals could do?
verb generationWord (covert)4UnknownUnknown
restNone4N/AN/A
Conditions notes

Contrasts

Are the contrasts clearly described?Yes

Contrast 1: verb generation vs rest

Language conditionVerb generation
Control conditionRest
Are the conditions matched for visual demands?Yes
Are the conditions matched for auditory demands?No
Are the conditions matched for motor demands?Yes
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Is reaction time matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Behavioral data notes
Are control data reported in this paper or another that is referenced?Somewhat
Does the contrast selectively activate plausible relevant language regions in the control group?Unknown
Are activations lateralized in the control data?Unknown
Control activation notesControl data in Herholz et al. (1996); insufficient to fully validate the contrast
Contrast notes

Analyses

Are the analyses clearly described?Yes

ROI analysis 1

First level contrastVerb generation vs rest
Analysis classLongitudinal change in aphasia
Group(s)Aphasia T2 vs T1 (regardless of rTMS)
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeLaterality indi(ces)
How many ROIs are there?3
What are the ROI(s)?(1) IFG LI; (2) superior temporal LI; (3) SMA LI
How are the ROI(s) defined?
Correction for multiple comparisonsNo correction
Statistical details
FindingsNone
Findings notes

ROI analysis 2

First level contrastVerb generation vs rest
Analysis classLongitudinal change in aphasia
Group(s)Aphasia treated with rTMS (n = 6) T2 vs T1
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeLaterality indi(ces)
How many ROIs are there?3
What are the ROI(s)?(1) IFG LI; (2) superior temporal LI; (3) SMA LI
How are the ROI(s) defined?
Correction for multiple comparisonsNo correction
Statistical details
FindingsNone
Findings notes

ROI analysis 3

First level contrastVerb generation vs rest
Analysis classLongitudinal between two groups with aphasia
Group(s)(Aphasia with R IFG rTMS (n = 6) T2 vs T1) vs (with sham rTMS (n = 4) T2 vs T1)
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeLaterality indi(ces)
How many ROIs are there?3
What are the ROI(s)?(1) IFG LI; (2) superior temporal LI; (3) SMA LI
How are the ROI(s) defined?
Correction for multiple comparisonsNo correction
Statistical details
Findings↑ LI (frontal)
Findings notesIFG LI was stable in the stimulation group, but shifted to the R in the sham group, yielding a significant difference between groups

ROI analysis 4

First level contrastVerb generation vs rest
Analysis classLongitudinal correlation with language or other measure
Group(s)Aphasia T2 vs T1 (regardless of rTMS)
CovariateΔ AAT total score
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegion of interest (ROI)
ROI typeLaterality indi(ces)
How many ROIs are there?1
What are the ROI(s)?IFG LI
How are the ROI(s) defined?
Correction for multiple comparisonsOne only
Statistical details
FindingsNone
Findings notes

Notes

Excluded analyses(1) difference between groups at T1 (pre-treatment); (2) sham group T2 vs T1 (n = 4)