Constraint-Induced Aphasia Therapy combined with tDCS

Among all the contemporary methods of speech rehabilitation after stroke the Constraint-Induced Aphasia Therapy, CIAT (Pulvermüller et al., 2001) is especially remarkable. This therapy was developed precisely for restoration of language functions in chronic stage of aphasia. It is based on principles of forced use of speech and high training intensity. The method was proved to be effective for patients with chronic post-stroke aphasia.

The effect of Constraint-Induced Aphasia Therapy in the chronic post-stroke stage can also be enhanced by direct reactivation of the cells of the brain substrate, for example, through transcranial direct current stimulation (tDCS). This is a method of brain stimulation, used worldwide in the treatment of a number of neurological diseases, including disorders of speech functions after a stroke. The scientific question now open is how much tDCS enhances the effect of intensive speech therapy sessions.

The combination of Constraint-Induced Aphasia Therapy with tDCS within a blind randomized protocol will make a significant contribution to
understanding the prospects for the mass use of tDCS for speech rehabilitation after a stroke.

To determine the degree of recovery of speech, extensive testing of speech functions with participants is carried out before and after therapy (in particular, the Russian Aphasiological Test is used). Also, before and after therapy, magnetoencephalography (MEG) is performed with each participant. MEG allows to record weak magnetic fields arising from the transmission of electrical impulses by nerve cells of the brain, and to establish the location of the sources of these magnetic fields in the brain. This method will allow to identify predictors of successful speech rehabilitation.

The therapy is carried out at the Center for Speech Pathology and Neurorehabilitation. For two weeks of rehabilitation, three hours each day, participants receive Constraint-Induced Aphasia Therapy combined with tDCS instead of the standard speech therapy, conducted at the Center. Therapy is conducted in a group of three patients in a form of a game: the participants sit at a special table with partitions, they are handed out cards with the image of objects, people and animals. The task is to find a pair of each card from another player, describing the depicted object or situation occurring with it. Two specialists take part in each session: one sits as a player at the table so that patients can navigate to his descriptions, the second leads the game and helps participants in case of difficulty.

The results of this project will have both a significant practical and fundamental scientific value. The practical impact of the project is to discover the predictors of successful recovery of stroke patients after speech therapy. These predictors would become a very important means of an effective individualized approach to speech rehabilitation of stroke patients. In addition, the project would have a high fundamental scientific value. The reorganization of speech functions after stroke is a unique model to be used for studying brain plasticity, its general principles and particular patterns. In this project neurophysiological markers of reorganization of speech neural networks will be studied on the basis of magnetoencephalographic data.

Hence, the project will provide valuable conclusions about recovery potential associated with brain reorganization processes and compensation of cognitive dysfunctions.

Publications

Kuptsova S., Ivanova M., Akinina Y., Iskra E., Kozintseva E., Soloukhina O., Petrushevsky A., Fedina O. N. Reorganization of cerebral functional activity in persons with aphasia following language therapy // Stem-, Spraak- en Taalpathologie. 2016. P. 93-95.