EXPRESS: Treatment of post-stroke aphasia: A Narrative Review for Stroke Neurologists

2021 ◽  
pp. 174749302110178
Author(s):  
Emilia Vitti ◽  
Argye E Hillis
Keyword(s):  
Brain Stimulation ◽  
Behavioral Therapy ◽  
Review Literature ◽  
Narrative Review ◽  
Optimal Management ◽  
Language Therapy ◽  
Post Stroke ◽  
Non Invasive ◽  
Aphasia Treatment

This review is intended to help physicians guide patients to optimal management of post-stroke aphasia. We review literature on post-stroke aphasia treatment, focusing on: (1) when and for whom language therapy is most effective, (2) the variety of approaches that can be effective for different individuals, and (3) the extent to which behavioral therapy might be augmented by non-invasive brain stimulation and/or medications.

scholarly journals Current Approaches to the Treatment of Post-Stroke Aphasia

2021 ◽  
Vol 23 (2) ◽  
pp. 183-201
Author(s):  
Julius Fridriksson ◽  
Argye Elizabeth Hillis
Keyword(s):  
Language Processing ◽  
Brain Stimulation ◽  
Behavioral Therapy ◽  
Social Activity ◽  
Phase Iii ◽  
Language Therapy ◽  
Phase Ii Trials ◽  
Post Stroke ◽  
Aphasia Therapy ◽  
Behavioral Therapies

Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.

Acquired disorders of language and their treatment

2020 ◽  
pp. 279-290
Author(s):  
Alex Leff ◽  
Jenny Crinion
Keyword(s):  
Drug Therapy ◽  
Brain Stimulation ◽  
Main Part ◽  
Evidence Base ◽  
Language Therapy ◽  
Stroke Patients ◽  
Speech And Language Therapy ◽  
Non Invasive ◽  
Aphasia Therapy

This chapter covers the classification of acquired aphasic syndromes. It illustrates some of the speech errors aphasic stroke patients make with videos of a patient describing a picture and attempting to repeat words. The main part of the chapter assesses the evidence base for speech and language therapy (SALT) and answers the following questions: Does SALT work? What is the correct dose and intensity? And is it ever too late for SALT intervention? We then discuss two main adjuvants to SALT: one old—drug therapy; one new—non-invasive brain stimulation. Finally, we examine the role for e-rehabilitation and augmentative aids before asking what the future might hold for aphasia therapy, and wondering if it might already be here.

Can neuromodulation techniques optimally exploit cerebello-thalamo-cortical circuit properties to enhance motor learning post-stroke?

2019 ◽  
Vol 30 (8) ◽  
pp. 821-837 ◽  
Author(s):  
Sharon Israely ◽  
Gerry Leisman
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Animal Studies ◽  
Motor Recovery ◽  
Motor Deficits ◽  
Post Stroke ◽  
Non Invasive ◽  
Deep Brain

Abstract Individuals post-stroke sustain motor deficits years after the stroke. Despite recent advancements in the applications of non-invasive brain stimulation techniques and Deep Brain Stimulation in humans, there is a lack of evidence supporting their use for rehabilitation after brain lesions. Non-invasive brain stimulation is already in use for treating motor deficits in individuals with Parkinson’s disease and post-stroke. Deep Brain Stimulation has become an established treatment for individuals with movement disorders, such as Parkinson’s disease, essential tremor, epilepsy, cerebral palsy and dystonia. It has also been utilized for the treatment of Tourette’s syndrome, Alzheimer’s disease and neuropsychiatric conditions such as obsessive-compulsive disorder, major depression and anorexia nervosa. There exists growing scientific knowledge from animal studies supporting the use of Deep Brain Stimulation to enhance motor recovery after brain damage. Nevertheless, these results are currently not applicable to humans. This review details the current literature supporting the use of these techniques to enhance motor recovery, both from human and animal studies, aiming to encourage development in this domain.

The applicability of motor learning to neurorehabilitation

2015 ◽  
pp. 55-64 ◽  
Author(s):  
John W. Krakauer
Keyword(s):  
Motor Learning ◽  
Brain Stimulation ◽  
Chronic Phase ◽  
Sensitive Period ◽  
Biological Recovery ◽  
Learning Mechanism ◽  
Post Stroke ◽  
Non Invasive

Rehabilitation is a form of directed training and is therefore predicated on the idea that patients respond to such training by learning. Current concepts in motor learning are reviewed. Recovery is not synonymous with re-learning and that it is important to be specific about what learning mechanism is being targeted by any given therapy. There is a unique milieu of heightened plasticity post-stroke that is responsible for reduction in impairment both through spontaneous biological recovery and increased responsiveness to training. In the chronic phase of stroke, plasticity returns to normal levels and learning for the most part only leads to task-specific compensation. Thus, new forms of intervention may have quite distinct effects depending on whether they are initiated in the sensitive period after stroke or in the chronic phase. It is to be hoped that new pharmacological and non-invasive brain stimulation approaches will allow the post-stroke sensitive period to be augmented, extended, and re-opened.

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