Journal
NEUROPSYCHOLOGY REVIEW
Volume 21, Issue 3, Pages 288-301Publisher
SPRINGER
DOI: 10.1007/s11065-011-9181-y
Keywords
Transcranial direct current stimulation; tDCS; Transcranial magnetic stimulation; TMS; Broca's aphasia; Language; Stroke; Neurorehabilitation
Categories
Funding
- National Institute of Neurological Disorders and Stroke [R01 DC008796]
- Mary Crown and William Ellis Family Fund
- Rosalyn and Richard Slifka Family Fund
- Deborah Munroe Noonan Memorial Research Fund
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Aphasia is a common symptom after left hemispheric stroke. Neuroimaging techniques over the last 10-15 years have described two general trends: Patients with small left hemisphere strokes tend to recruit perilesional areas, while patients with large left hemisphere lesions recruit mainly homotopic regions in the right hemisphere. Non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been employed to facilitate recovery by stimulating lesional and contralesional regions. The majority of these brain stimulation studies have attempted to block homotopic regions in the right posterior inferior frontal gyrus (IFG) to affect a presumed disinhibited right IFG (triangular portion). Other studies have used anodal or excitatory tDCS to stimulate the contralesional (right) fronto-temporal region or parts of the intact left IFG and perilesional regions to improve speech-motor output. It remains unclear whether the interhemispheric disinhibition model, which is the basis for motor cortex stimulation studies, also applies to the language system. Future studies could address a number of issues, including: the effect of lesion location on current density distribution, timing of the intervention with regard to stroke onset, whether brain stimulation should be combined with behavioral therapy, and whether multiple brain sites should be stimulated. A better understanding of the predictors of recovery from natural outcome studies would also help to inform study design, and the selection of clinically meaningful outcome measures in future studies.
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