Search Abstracts | Symposia | Slide Sessions | Poster Sessions
Language improvement following a Transcranial Magnetic Stimulation protocol in chronic post-stroke aphasia: evidence from two case studies
Poster Session B, Friday, September 12, 4:30 - 6:00 pm, Field House
Giovanna de Oliveira Santos1, Analía Arévalo1, Leônidas Gomes Angelim2, Rafaela Pagani Palermo3, Patrícia Silva de Carmargo2, Sérgio Henriques4, Guilherme Lepski1,4,5; 1University of São Paulo Medical School, 2Institute of Bioscences, University of São Paulo, 3Santa Casa de São Paulo School of Medical Sciences, 4Institute of Neurosurgery, São Paulo, Brazil, 5Eberhard Karls University
Transcranial magnetic stimulation (TMS) has been increasingly explored as a non-invasive approach for neurorehabilitation in different neurological and psychiatric conditions. Protocols specific for post-stroke aphasia have been published, but its effectiveness remains under investigation. In this work, we report two case studies of chronic stroke patients with severe aphasia (CR, a 69-year-old female and GC, a 49-year-old male) who underwent a TMS protocol adapted from the Northstar-CA model (Zumbansen et.al., 2022). The intervention consisted of daily sessions of 1 Hz stimulation of the contralesional pars triangularis (inferior frontal gyrus), delivering 900 pulses over 15 minutes for 15 consecutive days, immediately followed by 45-minute speech-language therapy sessions. A comprehensive language assessment was conducted before (day 1) and after (day 15) the protocol, including 11 tasks covering semantic, phonological, and syntactic processing in both oral and written modalities. After the intervention, both patients showed improvements in several tasks, measured as the difference in weighted scores at post-TMS compared to pre-TMS testing, particularly in writing (GC ∆post-pre = 1.0; CR ∆post-pre = 1.0), reading of words (GC ∆post-pre = 0.16; CR ∆post-pre = 0.5) and pseudowords (CR ∆post-pre = 0.125), repetition of words (GC ∆post-pre = 0.21; CR ∆post-pre = 0.42) and pseudowords (GC ∆post-pre = 0.07; CR ∆post-pre = 0.5), and image (visual) comprehension (GC ∆post-pre = 0.17; CR ∆post-pre = 0.67). Additional individual gains were observed, such as improved diadochokinesis and semantic verbal fluency in patient GC (diadochokinesis ∆post-pre = 0.38; semantic verbal fluency ∆post-pre = 0.5). Interviews with family members and reports from the clinical staff also indicated marked language improvements, specifically during day-to-day tasks and in perceived contrast to baseline performance. In patient CR, improvement was markedly greater during the post-TMS period than before treatment (even though these time frames were similar and no new TMS protocols were applied), suggesting TMS protocols may confer relatively long-lasting effects whose underlying mechanisms we have yet to elucidate. These preliminary findings suggest that the combination of TMS and behavioral therapy support language recovery in chronic aphasia, although further studies are needed to evaluate the long-term maintenance of these benefits and the role of emotional and motivational factors in the rehabilitation process.
Topic Areas: Disorders: Acquired, Methods