| Authors | Szaflarski JP, Vannest J, Wu SW, DiFrancesco MW, Banks C, Gilbert DL |
| Title | Excitatory repetitive transcranial magnetic stimulation induces improvements in chronic post-stroke aphasia |
| Reference | Med Sci Monit 2011; 17: CR132-139 |
| PMID | 21358599 |
| DOI | 10.12659/msm.881446 |
| Language | US English |
| Inclusion criteria | Moderate aphasia, L MCA |
| Number of individuals with aphasia | 8 (plus 3 excluded: 2 metallic artifact; 1 seizure at time of stroke) |
| Number of control participants | 0 |
| Were any of the participants included in any previous studies? | No |
| Is age reported for patients and controls, and matched? | Yes (mean 54.4 ± 12.7 years) |
| Is sex reported for patients and controls, and matched? | Yes (males: 4; females: 4) |
| Is handedness reported for patients and controls, and matched? | Yes (right: 8; left: 0) |
| Is time post stroke onset reported and appropriate to the study design? | Yes (mean 5.3 ± 3.6 years, > 12 months) |
| To what extent is the nature of aphasia characterized? | Severity and type |
| Language evaluation | BNT; phonemic fluency, semantic fluency, complex ideation from BDAE, PPVT, communicative activities log |
| Aphasia severity | Moderate |
| Aphasia type | 4 Broca's, 3 anomic, 1 anomic/conduction |
| First stroke only? | Not stated |
| Stroke type | Not stated |
| To what extent is the lesion distribution characterized? | Individual lesions |
| Lesion extent | Not stated |
| Lesion location | L MCA |
| Participants notes | — |
| Modality | fMRI |
| Is the study cross-sectional or longitudinal? | Longitudinal—chronic treatment |
| If longitudinal, at what time point(s) were imaging data acquired? | T1: pre-treatment/chronic; T2: post-treatment, ~2 weeks later |
| If longitudinal, was there any intervention between the time points? | RTMS to residual activation near Broca's area, 5 sessions/week, 2 weeks |
| Is the scanner described? | Yes (Varian Unity INOVA 4 T) |
| Is the timing of stimulus presentation and image acquisition clearly described and appropriate? | No (timing not clear, because previous studies cited are not all identical in terms of timing) |
| Design type | Block |
| Total images acquired | not stated |
| 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? | No (lesion impact not addressed) |
| Imaging notes | — |
| Are the conditions clearly described? | No (based on Binder et al. (1997), but details not reported) |
| Condition | Response type | Repetitions | All groups could do? | All individuals could do? |
|---|---|---|---|---|
| semantic decision | Button press | not stated | Unknown | No |
| tone decision | Button press | not stated | Unknown | No |
| Conditions notes | Group only just above chance, unclear whether significantly better; clearly some individuals were at chance |
| Are the contrasts clearly described? | Yes |
| Language condition | Semantic decision |
| Control condition | Tone decision |
| Are the conditions matched for visual demands? | Yes |
| Are the conditions matched for auditory demands? | Yes |
| Are the conditions matched for motor demands? | Yes |
| Are the conditions matched for cognitive/executive demands? | Yes |
| Is accuracy matched between the language and control tasks for all relevant groups? | Appear similar |
| Is reaction time matched between the language and control tasks for all relevant groups? | Unknown, not reported |
| Behavioral data notes | — |
| Are control data reported in this paper or another that is referenced? | Yes |
| Does the contrast selectively activate plausible relevant language regions in the control group? | Yes |
| Are activations lateralized in the control data? | Yes |
| Control activation notes | Control data in Kim et al. (2011) and Szaflarski et al. (2008); L frontal and temporal, plus other semantic regions |
| Contrast notes | — |
| Are the analyses clearly described? | No* (moderate limitation) (see specific limitation(s) below) |
| First level contrast | Semantic decision vs tone decision |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia T2 vs T1 |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (patients improved only on semantic fluency) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | Language and control tasks both matched |
| Type of analysis | Voxelwise |
| Search volume | Whole brain |
| Correction for multiple comparisons | No correction |
| Software | in-house |
| Voxelwise p | .05 |
| Cluster extent | None |
| Statistical details | The figure shows a cutoff of z > 10, which would not correspond to p < .05; increases and decreases in Figure 3 do not accord with the data from T1 and T2 in Figure 2, raising concerns about the implementation of the analyses; there is no explicit description of the second level analysis |
| Findings | ↑ L IFG ↑ L SMA/medial prefrontal ↑ L orbitofrontal ↑ L inferior parietal lobule ↑ L supramarginal gyrus ↑ L angular gyrus ↑ L precuneus ↑ L occipital ↑ L anterior cingulate ↑ L basal ganglia ↑ L hippocampus/MTL ↑ R dorsal precentral ↑ R precuneus ↑ R occipital ↑ R basal ganglia ↑ R hippocampus/MTL ↓ R insula ↓ R supramarginal gyrus ↓ R posterior STG |
| Findings notes | Based on a combination of coordinates in Table 2, and Figure 3 |
| First level contrast | Semantic decision vs tone decision |
| Analysis class | Longitudinal change in aphasia |
| Group(s) | Aphasia T2 vs T1 |
| Covariate | — |
| Is the second level contrast valid in terms of the group(s), time point(s), and measures involved? | Somewhat (patients improved only on semantic fluency) |
| Is accuracy matched across the second level contrast? | Yes, matched |
| Is reaction time matched across the second level contrast? | Unknown, not reported |
| Behavioral data notes | Language and control tasks both matched |
| Type of analysis | Regions of interest (ROI) |
| ROI type | Functional |
| How many ROIs are there? | 3 |
| What are the ROI(s)? | (1) frontal LI; (2) temporal LI; (3) language network LI |
| How are the ROI(s) defined? | |
| Correction for multiple comparisons | No correction |
| Statistical details | T1 LI (temporal) is reported to be negative, which does not accord with the voxelwise analysis in Figure 2; increases and decreases in Figure 3 do not accord with the data from T1 and T2 in Figure 2, raising concerns about the implementation of the analyses |
| Findings | ↑ LI (language network) ↑ LI (frontal) ↑ LI (temporal) |
| Findings notes | — |
| Excluded analyses | — |
