Short-Term Anomia Training and Electrical
Brain Stimulation
Agnes Flöel, MD; Marcus Meinzer, PhD; Robert Kirstein; Sarah Nijhof; Michael Deppe, PhD;
Stefan Knecht, MD; Caterina Breitenstein, PhD
Downloaded from http://stroke.ahajournals.org/ by guest on June 16, 2017
Background and Purpose—Language training success in chronic aphasia remains only moderate. Electric brain
stimulation may be a viable way to enhance treatment efficacy.
Methods—In a randomized, double-blind, sham-controlled crossover trial, we assessed if anodal transcranial direct current
stimulation compared to cathodal transcranial direct current stimulation and sham stimulation over the right
temporo-parietal cortex would improve the success of short-term high-frequency anomia training. Twelve chronic
poststroke aphasia patients were studied. Naming outcome was assessed after training and 2 weeks later.
Results—All training conditions led to a significant increase in naming ability, which was retained for at least 2 weeks after
the end of the training. Application of anodal transcranial direct current stimulation significantly enhanced the overall
training effect compared to sham stimulation. Baseline naming ability significantly predicted anodal transcranial direct
current stimulation effects.
Conclusions—Anodal transcranial direct current stimulation applied over the nonlanguage dominant hemisphere can
enhance language training outcome in chronic aphasia.
Clinical Trial Registration—URL: www.clinicaltrials.gov/. Unique identifier: NCT00822068.
(Stroke. 2011;42:2065-2067.)
Key Words: anomia 䡲 neurorehabilitation 䡲 transcranial direct current stimulation
T
he most frequent symptom in poststroke aphasia is
impaired word retrieval (anomia). Training at a sufficient
intensity may significantly improve aphasic symptoms, but
chronic anomia is relatively resistant to intervention and
training adjuvant therapies need to be devised.1
Excitatory (anodal) transcranial direct current stimulation
over left hemisphere areas has been shown to facilitate
language learning in healthy subjects and aphasia patients.1,2
However, the exact areas that contribute to language relearning success are still controversial,3 and it remains unclear
which brain areas should be facilitated. A recent study
implicated right temporo-parietal areas with anomia treatment success.4 Thus, we explored whether anodal transcranial
direct current stimulation of this area can enhance the
outcome of high-frequency short-term anomia training. In a
randomized, double-blind crossover design, patients also
participated in inhibitory (cathodal) transcranial direct current
stimulation and placebo stimulation (sham) sessions. We
hypothesized that anodal transcranial direct current stimulation would lead to more pronounced treatment gains compared to training under cathodal or sham stimulations.
Materials and Methods
Twelve patients with chronic anomia because of a first-time single
left hemisphere ischemic stroke participated. All patients completed
a baseline neurological examination and standardized language
testing. Supplemental Table I (http://stroke.ahajournals.org) summarizes demographic and clinical sample characteristics. Supplemental Figure I (http://stroke.ahajournals.org) shows the lesion
location of the patients. The local ethics committee approved the
study and written informed consent was obtained from all
patients.
For the anomia training, 45 pictures depicting common objects
were individually selected for each patient (“trained objects”). These
objects had been named incorrectly 3 times during 3 baseline runs
comprising a standardized set of 344 object pictures. The 45 objects
were divided into 3 sets of 15 objects matched for several linguistic
variables. Patients took part in 3 consecutive training phases, each
with a different stimulation condition (anodal or cathodal transcranial direct current stimulation and sham; sequence randomized
across patients). During each phase, 1 of the sets was trained.
Between stimulation conditions, an interval of 3 weeks was maintained (Figure 1A).
For each condition, patients received 2 hours of daily computerassisted naming therapy across 3 consecutive days. Training involved a decreasing cueing hierarchy with 5 difficulty levels that
have been shown to be highly effective to improve anomia.4
Short-term and long-term treatment effects for the 3 conditions were
Received November 18, 2010; accepted February 15, 2011.
From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin,
Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany.
The online-only Data Supplement is available at http://stroke.ahajournals.org/cgi/content/full/STROKEAHA.110.609032/DC1.
Argye E. Hillis, MD, MA, was the Guest Editor for this paper.
Correspondence to Agnes Flöel, MD, Charité Universitätsmedizin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany. E-mail
[email protected]
© 2011 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.110.609032
2065
2066
Stroke
July 2011
Figure 1. A, Subjects participated in 3
training and stimulation sessions. Posttesting was performed immediately after
training and 2 weeks afterward. B, A
training session. C, Transcranial direct
current stimulation (tDCS) site is shown in
red on head (yellow dots indicate standard 10- to 20-electroencephalogram
system).
Downloaded from http://stroke.ahajournals.org/ by guest on June 16, 2017
assessed during separate testing sessions in the afternoon of the third
training day and 2 weeks after training. During these assessments,
the 15 trained object names were probed 4 times in random order
without cues. To increase the sensitivity of the score, each correct
response was scored as 1 point.
Transcranial direct current stimulation was applied over right
temporo-parietal cortex according to Menke et al4 and centered on
Talairach coordinates 57/⫺30/3 (Figure 1C). Anodal or cathodal
transcranial direct current stimulations (1 mA) were administered
during the first 20 minutes of each training hour (Figure 1B). During
sham stimulation, the current was turned off slowly after 30 seconds.
Systolic blood pressure, heart rate, and subjective ratings of fatigue,
discomfort, or pain were also assessed and no differences between
the conditions were found
Statistical Analysis
Main outcome parameter was naming ability for trained objects
immediately after training and 2 weeks later (% correct naming). A
repeated-measures ANOVA with the factors stimulation and time
(immediately after training, 2 weeks later) was conducted to determine short-term and long-term training outcome. Pearson correlations of age, time since stroke, lesion size, and anomia severity
(Aachen Aphasia Test naming subtest; baseline naming ability of
344 objects) with training success (anodal or cathodal better than
sham) were calculated with Bonferroni corrected significance levels.
Results
Patients significantly improved after the training from 0% correct
naming responses at the baseline assessment to a mean of
83%⫾22% (Supplemental Table II, http://stroke.ahajournals.org)
correct responses after training (effect size pooled across
stimulation conditions and short-term and long-term training
outcome assessments, Cohen d⫽3.77).
A repeated-measures ANOVA with the repeated factors
stimulation and time yielded a main effect of stimulation
(F(2,22)⫽4.23; P⫽0.05). The effect remained significant after
exclusion of patient 8, with the greatest improvement using
anodal transcranial direct current stimulation (F(2,20)⫽5.77;
P⫽0.01). Because there were no significant effects for time, data
for short-term and long-term retentions were pooled for subsequent analyses. Post hoc tests revealed better overall improvement in the anodal condition compared to sham stimulation
(paired t test, t(11)⫽2.54; P⫽0.03; Figure 2). There was no
significant difference between cathodal and sham stimulations (t(11)⫽1.14; P⫽0.28). An exploratory analysis conducted separately for the 2 post-training assessments yielded
an additional significant effect for cathodal transcranial direct
current stimulation immediately after training (see Supplemental Materials, http://stroke.ahajournals.org). Anodal
transcranial direct current stimulation tended to produce more
pronounced effects than cathodal transcranial direct current
stimulation (T1: t(11)⫽1.4, P⫽0.1; T2: t(11)⫽1.8, P⫽0.05;
pooled data: t(11)⫽1.7, P⫽0.05).
Treatment success for both transcranial direct current
stimulation conditions was not associated with age, education, time since stroke, and lesion size. Poorer naming
performance before treatment was associated with more
pronounced improvement selectively during anodal transcranial direct current stimulation (Aachen Aphasia Test naming
subtest; r⫽⫺0.73, P⫽0.0067; 344 objects: r⫽⫺0.91,
P⬍0.0001).
Discussion
Our results demonstrate that short-term high-frequency anomia training has a large effect on naming ability in chronic
aphasia that was maintained for at least 2 weeks. Anodal
transcranial direct current stimulation, applied over the nonlanguage dominant hemisphere, further improved language
training outcome at both assessment points. Consistent with
previous reports,5 the beneficial effect of anodal transcranial
direct current stimulation cannot be explained by unspecific
arousal differences, because autonomic responses and mood
ratings were comparable across stimulation conditions. Cathodal transcranial direct current stimulation, which reduces
intracortical excitability in neurophysiological studies, resulted in a weaker and less consistent effect that was not
maintained.
Only 1 group study so far addressed transcranial direct
current stimulation effects on treatment-induced recovery and
found improved naming ability after anodal transcranial
direct current stimulation applied over perilesional areas in
relatively well-recovered anomia patients.1 However, in line
Flöel et al
Brain Stimulation in Aphasia
2067
Figure 2. Effects of the 3 stimulation conditions
(immediately after training, 2 weeks later, and
pooled effects; means/standard error of the mean).
*Significant differences between conditions at
P⬍0.05.
Downloaded from http://stroke.ahajournals.org/ by guest on June 16, 2017
with our own previous functional MRI study, upregulation of
right hemispheric homologues of “classical” language regions might be crucial in aphasia patients with only partial
recovery.4 This hypothesis was supported by the fact that
patients with more severe anomia showed more pronounced
gains after anodal transcranial direct current stimulation, and
at least 1 of the 2 more severely affected patients in the study
by Baker et al1 did not show improvement after left frontal
stimulation. However, this does not preclude the possibility
that patients with less severe aphasia in our study may have
benefited from left-side stimulation as well. The question of
whether left perilesional areas, or homologous areas of the
right hemisphere, are more crucial for recovery can be
addressed only in a study that directly compares anodal
transcranial direct current stimulation effects of these areas.
predicted anodal transcranial direct current stimulation effect.
However, predictors for a favorable response to this type of
stimulation remain to be more thoroughly delineated (see
Supplemental Materials for additional Methods, Results, and
Discussion, http://stroke.ahajournals.org).
Sources of Funding
Supported by German Science Foundation (Fl-379-4/2 379-8/1;
Exc-257; SFB-TR3 A08/A10); the Federal Ministry for Education
and Science (FKZ 0315673A; 01EO0801); Interdisciplinary Center
for Clinical Research Münster (Floe-3– 004-008); European Commission (MRTN-CT-2004-512141); and Neuromedical Foundation
Münster.
Disclosures
None.
References
Conclusions
In summary, transcranial direct current stimulation represents
a promising new tool to enhance treatment effects, can easily
be administered during behavioral treatment, and is less
expensive and aversive than repetitive transcranial magnetic
stimulation.5 Based on these promising results, implications
for clinical practice should be ascertained in larger multicenter trials. Moreover, the current study suggests that baseline naming ability, but not overall lesion size, significantly
1. Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke. 2010;41:1229 –1236.
2. Flöel A, Rösser N, Michka O, Knecht S, Breitenstein C. Noninvasive brain
stimulation improves language learning. J Cogn Neurosci. 2008;20:
1415–1422.
3. Meinzer M, Breitenstein C. Functional imaging of treatment-induced
recovery in chronic aphasia. Aphasiology. 2008;22:1251–1268.
4. Menke R, Meinzer M, Kugel H, Deppe M, Baumgartner A, Schiffbauer H,
et al. Imaging short- and long-term training success in chronic aphasia.
BMC Neurosci. 2009;10:118.
5. Schlaug G, Renga V, Nair D. Transcranial direct current stimulation in
stroke recovery. Arch Neurol. 2008;65:1571–1576.
Short-Term Anomia Training and Electrical Brain Stimulation
Agnes Flöel, Marcus Meinzer, Robert Kirstein, Sarah Nijhof, Michael Deppe, Stefan Knecht
and Caterina Breitenstein
Downloaded from http://stroke.ahajournals.org/ by guest on June 16, 2017
Stroke. 2011;42:2065-2067; originally published online June 2, 2011;
doi: 10.1161/STROKEAHA.110.609032
Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2011 American Heart Association, Inc. All rights reserved.
Print ISSN: 0039-2499. Online ISSN: 1524-4628
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http://stroke.ahajournals.org/content/42/7/2065
Data Supplement (unedited) at:
http://stroke.ahajournals.org/content/suppl/2011/06/02/STROKEAHA.110.609032.DC1
http://stroke.ahajournals.org/content/suppl/2012/08/21/STROKEAHA.110.609032.DC2
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Supplemental Materials
Supplemental Methods
Patients
Twelve patients (five women; mean age: 52.3 years, range 39-67) with chronic aphasia and
anomia due to a single first time left hemisphere ischemic stroke were included. None of the
patients had a stroke in the right hemisphere (see Supplemental Figure 1). All patients
have been right-handed prior to the stroke1 and native German speakers. Standardized
language testing was performed using the Aachen Aphasia Test (AAT).2 Patients with
severe apraxia of speech were excluded from the study. The study was registered under
ClinicalTrials.gov (NCT00822068) and conducted in accordance with the Helsinki
declaration.
Lesion size was determined by drawing lesion masks on the patients’ high resolution T1weighted MRI scans that were acquired in the context of the present study and available for
10 of the patients (see Supplemental Figure 1B). Afterwards, the scans and lesion masks
were normalized using unified normalization in SPM5.3 The number of voxels in the
respective normalized masks was then used to create a lesion overlay plot (Supplemental
Figure 1A) and to determine lesion size. No recent high resolution MRI scans were
available for two patients (patients # 5 and 8). For one of these patients (#5) a lesion mask
was drawn on a standard MRI template by an experienced neuroradiologist based on a CT
scan acquired in the chronic stage (Supplemental Figure 1C). This allowed us to estimate
lesion size. However, as the latter procedure is less accurate than determining lesion size
on high-resolution MRI scans, subsequent analyses involving lesion size as a variable are
reported with and without this patient. For patient #8 only a T2 weighted scan from the postacute stage was available (Supplemental Figure 1C). As the patient is suffering from
claustrophobia and was not willing to participate in an additional MRI scan, no recent lesion
1
information from the chronic stage was available. However, the clinical history, as well as
the neurological evaluation conducted for the present study, did not reveal any evidence for
further stroke events. As no reliable estimate of lesion size was possible for patient #8, the
patient was excluded from the analyses involving lesion size.
Details of the training procedure
For pragmatic reasons (i.e., cross-over design involving three training and stimulation
sessions for each patient) we used a shortened version of an anomia training protocol that
had successfully been used to treat naming impairments in chronic aphasia patients in prior
studies (see4-6 for detailed descriptions of the protocol). In the present study the training
involved two hours daily computer-assisted naming therapy across three consecutive days.
Training followed the method of “vanishing cues” and involved a decreasing cueing
hierarchy with five difficulty levels. At level one (easiest level), pictures were cued with the
spoken and written word form (i.e., repeating) until the patient scored >80% correct
responses. At level two, pictures were cued with the first two phonemes and graphemes, at
level three with the first phoneme and grapheme only. The first grapheme only was
presented at level four. Object naming without cues was required at level five (target level).
Whenever performance was lower than 80 percent correct (levels 2-5), a training block at
level one was interspersed to provide patients with the complete visual and auditory target
word forms. The training was supervised by a speech- and language therapist, who scored
each patient’s response. Two one-hour training sessions were administered in the morning
of each training day, separated by a short break. Each session comprised five training
blocks, with 60 naming trials, respectively. Each of the 15 trained objects occurred with a
high repetition rate during each block (four trials/object; four different object tokens) to
promote stable long-term memory consolidation (Figure 1B).
Prior to, in the middle, and immediately after each daily training session, systolic blood
pressure, heart rate, and subjective ratings of fatigue, discomfort, or pain using visual
2
analogue scales (range 1-10, 10= highest level of discomfort)7 and the Positive and Negative
Affect Scales (PANAS)8 were assessed. After the end of the study, patients were asked to
identify the respective stimulation sessions.
Training materials
The three sets of object names (15 each) selected for each patient (see Supplemental
Table 3 for a list of stimuli for each patient and stimulation condition) were taken from a
standardized picture corpus.6 The stimuli that were used in the three respective stimulation
conditions for each patient were matched for word-length (number of syllables), wordfrequency (Leipziger Wortschatz), name agreement, ratings of “how good of an exemplar
the respective picture is for a given word” and semantic categories using ANOVAs or Chisquare tests as appropriate. No significant differences between the three sets were found
for all patients (all p> .05).
Transcranial direct current stimulation (tDCS): tDCS was delivered by a battery-driven
constant direct current stimulator (Schneider Electronic, Gleichen, Germany). Constant
current flow was controlled by an amperemeter. The stimulating electrode (anodal
stimulation) was inserted in a 5x7 cm saline-soaked synthetic sponge and centered over right
temporo-parietal cortex (centered on Talairach coordinates 57/-30/3 using the Münster T2Tconverter
to
determine
position
on
the
scalp;
http://wwwneuro03.uni-
muenster.de/ger/t2tconv/; Figure 1C). The second electrode (reference; inserted in a 10x10
cm sponge) was positioned over the contralateral supraorbital region. The increased size of
the reference electrode renders stimulation functionally inefficient without compromising the
tDCS-generated effects under the active electrode.9
At the start of each training hour, either anodal or cathodal tDCS (1 mA) was delivered for 20
minutes. Initially, the current was increased in a ramp-like fashion, eliciting a transient tingling
sensation on the scalp that fades over seconds.10 The respective stimulation conditions
3
currents were subsequently turned off slowly out of the field of view of the patients, a
procedure that does not elicit perceptions.10 Thus, the patients were blinded for the
respective condition. The language training continued after the end of the 20 min.
stimulation. During sham stimulation, the current was turned off after 30 seconds. Stimulation
was administered by an investigator neither involved in the training nor in data analysis.
TDCS conditions were separated by more than 7 days (in the present study by 3 weeks), to
avoid any carry-over effects of the stimulation.11
Additional statistical analyses
Normal distribution of all dependent variables was ensured (Kolmogorow-Smirnov test) and
log transformations performed if appropriate.
Even though the factor TIME did not reach significance, we conducted an exploratory
analysis separately for the two time points (immediately after training, two weeks after the
end of the training). Specifically, paired t-tests were used to explore the effects of anodal and
cathodal stimulation compared with sham stimulation for each time-point.
To assess unspecific arousal effects, a repeated measures ANOVA (ANOVARM) was used to
test the influence of the repeated factors TRAINING DAY, TIMEbeginning/middle/end
of session
and
STIMULATION on systolic blood pressure, diastolic blood pressure, heart rate, as well as
fatigue, discomfort, or pain and the positive and negative mood ratings (PANAS) over the
course of the training days. Greenhouse–Geisser corrections were used for within-subjecteffects. STIMULATION differences were analyzed with post-hoc paired t-tests, as
appropriate. Significance level was set to p≤0.05.
4
Supplemental Results
Exploratory analysis of the impact of assessment point
Anodal tDCS resulted in more pronounced improvements compared to sham stimulation at
both assessment points (all t(11)’s >2.2, all p’s<.03)). In addition, cathodal tDCS resulted in
more pronounced gains compared to sham immediately after training (t(11)=2.4, p=.02),
however, this effect was not maintained at the follow-up assessment (t(11)=.13, p=.44).
Figure 2 visualizes the degree of improvement under the respective stimulation conditions.
While the effect of atDCS was negatively correlated with aphasia severity (please see main
manuscript), no correlations were found for the effects of ctDCS immediately after training or
two weeks later.
Impact of arousal
Blood pressure and heart rate were comparable across the three stimulation conditions, as
indicated by the non-significant effects for the factor STIMULATION in the respective
ANOVA. Discomfort (due to the headband), pain, and fatigue were negligible in all patients
(range between 1 and 2 out of 10), and comparable in the three STIMULATION conditions.
Positive and negative mood ratings were not significantly different across the three
STIMULATIONs. No participant was able to distinguish between the stimulation conditions.
Impact of the lesion
Lesion size was not correlated with baseline naming ability or overall aphasia severity
(N=10 patients with MRI scans: AAT naming: r=-.08, p=.82; baseline naming of 344 objects:
r=-.30, p=.38; AAT profile score: r=-.25, p=.47; N=11 patients: AAT naming: r=-.11, p=.73;
344 objects: r=-.27, p=.40; AAT profile score: r=-.33, p=.31). In addition, we found that
lesion size was not a reliable predictor of treatment outcome under any of the stimulation
conditions [N=10 patients with MRI: anodal alone r=-.27, p=.43; anodal > sham: r=-.40,
5
p=.24; other conditions: all r=-.43-.04, p=.21-.98; N=11 patients: anodal: r=-.27, p=.41;
anodal > sham: r=-.34, p=.29; other conditions: all r= -.18-.02; p=.59-.93].
Supplemental Discussion and Limitations
The training paradigm we used in the present study comprised a shortened version of an
anomia training developed in our workgroup which has been shown to be highly effective to
improve word-retrieval difficulties in chronic aphasia patients in several recent studies.4-6
However, in contrast to previous studies that administered the training over 10 consecutive
workdays, we used a shortened version comprising six hours of training spread across
three consecutive days. For the within-subjects cross-over design we used it was crucial to
implement a time-frame that would be acceptable for the patients, and that would allow to
test the same number of matched words in each of the three conditions (anodal vs.
cathodal vs. sham). Even though the intervention period in the present proof-of-principle
study was short, the frequency was high and the number of hours per week was within the
range required for successful behavioural interventions.12-13 Indeed, naming performance
improved in all training phases (on average 83% improvement across all conditions) and
even during the sham stimulation condition (79±26% above baseline) which corroborates
the effectiveness of such a short-term high-frequency training approach. However, future
studies should use more stimuli which is only possible with more extended training periods
to achieve a high repetition rate for each training stimuli and to increase the clinical
relevance of the training. Moreover, we only selected stimuli that could not be named
correctly three consecutive times by the patients prior to the training. This allowed us to
carefully match the training stimuli and to compare the effects of the three stimulation
conditions (i.e., the main aim of the study). However, at the same time, such a low baseline
score may bias the actual treatment effects towards larger treatment gains. In addition,
even though there was high consistency across three baseline runs, future studies may be
advised to collect a larger number of pre-treatment probes to further reduce the possibility
of random performance fluctuations.
6
We hypothesized that atDCS would lead to more pronounced treatment gains than ctDCS or
sham stimulations. This hypothesis was confirmed for atDCS vs. sham in the ANOVA (see
main manuscript) and the subsequent post hoc analyses: Here, it was found that atDCS
induced significantly more pronounced effects when compared to sham stimulation (pooled
effect and separately for both time points). However, trends were also seen for the
comparison between anodal vs. cathodal stimulations (marginally significant at T2). In an
exploratory analysis, more pronounced gains were found for ctDCS when compared to sham
immediately after training. However, these gains were less pronounced and more variable
than the effects of atDCS, were not maintained two weeks after treatment, and no overall
effect (pooled analysis) was found (see Figure 2). It is possible that in some patients,
inhibition of right hemispheric brain areas may have resulted in improved functioning
(presumably by reduced interference with left hemisphere perilesional activity).14 This may
have been the reason for the transient positive effects of ctDCS in some of the patients,
which explained the overall effect of ctDCS immediately after training.
However, please note that in several previous studies that tried to modulate language
functions, only effects of anodal but not cathodal tDCS were found
showed a significant inhibitory action by cathodal tDCS
18-20
15-17
. Those studies that
stimulated with >1 mA (in the
present study, we decided on 1 mA for safety reasons; previous studies11, 17 in stroke patients
had not used higher intensities up to the start of our study). This might explain the overall
negative effect of ctDCS in our study (pooled analysis).
One previous study found a significant effect of ctDCS in aphasia patients,19 namely,
improvement of naming after left prefrontal ctDCS (10 minutes, 2mA). However, this study
not only used different stimulation parameters (10 min of 2mA vs. 20 min of 1 mA in our
study) and administered stimulation over different brain areas (left prefrontal vs. right
temporo-parietal cortex), but also used a different study design: In this study, 20 pictures
were named once before and once after the respective tDCS stimulation, and the outcome
7
was calculated from this naming score. This “immediate effect on performance“ is vastly
different from the present study, where we used tDCS in conjunction with a learning task,
over several sessions. Moreover, the results from Monti et al. are not in line with the findings
from Baker et al.21 who showed that anodal tDCS over the left prefrontal cortex resulted in a
more favourable treatment response in chronic aphasia. However, the question of whether
ctDCS resulted in a transient down-regulation of right posterior brain regions (and an upregulation of perilesional areas) in our own study needs to be addressed in future studies
using functional imaging techniques.
Several additional limitations need to be discussed: We aimed to determine if intensive
naming training success in chronic anomia may be enhanced by tDCS. The results can
therefore not be generalized to other types of language training (e.g., non-intensive training,
other language modalities). Moreover, we did not determine individual pre-training brain
activity using functional imaging, but rather stimulated an area that has been correlated with
improved performance in a sample of chronic aphasia patients with moderate to severe
anomia. However, given the high comparability of the patient groups and treatments in the
two studies, similar brain areas are likely implicated. This is also supported by the fact that
patients with more severe anomia (but not lesion size, which is not necessarily a reliable
predictor of spontaneous or treatment-induced aphasia recovery per se22-24 or of response
to training-adjuvant atDCS),21 responded better to atDCS than patients with mild anomia. In
particular, in patients with mild anomia, anodal stimulation of left-hemisphere areas might
have resulted in more pronounced improvement. However, our study cannot address the
issue whether stimulation of left perilesional or homologous areas of the right hemisphere is
more crucial for recovery. This needs to be addressed in future studies involving larger
number of patients, atDCS of perilesional versus right hemispheric areas, and additional
functional imaging to determine language network plasticity and to corroborate the
presumed effects of atDCS (i.e., upregulation of right hemisphere posterior temporoparietal areas as a consequence of treatment and stimulation). On the other hand, for use
8
in a clinical setting, areas common to a particular group of patients have to be identified, to
be stimulated without the need of preceding fMRI in individual patients. Thus, the present
approach may ultimately allow the incorporation of the tDCS technique into large scale
clinical
studies,
similar
to
clinical
trials
in
the
motor
system
(http://clinicaltrials.gov/ct2/show/NCT00909714).
9
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Meinzer M, Mohammadi S, Kugel H, Schiffbauer H, Floel A, Albers J, et al. Integrity of
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Menke R, Meinzer M, Kugel H, Deppe M, Baumgartner A, Schiffbauer H, et al.
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Folstein MF, Luria R. Reliability, validity, and clinical application of the visual
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Watson D, Clark LA, Tellegen A. Development and validation of brief measures of
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Neurophysiol. 2007;97:3109-3117
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12
Supplemental Table 1 Clinical and demographic information of the patient sample
AAT
Token Test
ID
Sex
Age
Time since
Lesion
Education
Baseline
(years)
stroke (months)
Size
(years)
Naming
AAT
correct 1
profile
(cm3)
max. 50
errors (PR)
Written
Repetition
Language
Naming*
Comprehension
max. 150
max. 90
max. 120
max. 120
AAT
points
points
points
points
syndrome
(PR)
(PR)
(PR)
(PR)
01
m
61
49
68.2
18
85.2%
65.07
9 (83)
143 (89)
89 (99)
103 (84)
113 (99)
amnestic
02
m
39
260
394.9
18
73.8%
58.05
5 (93)
123 (64)
77 (84)
90 (63)
113 (99)
Broca
03
f
41
118
170.8
12
86.0%
58.38
18 (68)
117 (56)
73 (77)
111(96)
116 (100)
Broca
04
m
59
86
183.2
18
68.1%
50.42
23 (58)
97 (39)
52 (53)
89 (62)
88 (64)
Broca
05
m
67
59
122.6
12
86.3%
59.98
8 (86)
142(88)
57 (59)
109(93)
103 (89)
Broca
06
m
50
101
287.0
5
78.8%
51.96
23 (58)
119 (58)
60 (61)
72 (46)
98 (81)
Broca
07
m
47
110
182.9
9
51.9%
49.81
41 (24)
116 (55)
37 (42)
94 (70)
82 (55)
Broca
08
f
60
100
n/a
5
3.8%
39.82
50 (2)
101 (42)
0 (5)
22 (21)
51 (21)
global
09
f
50
22
67.5
13
83.1%
64.93
0 (99)
140 (86)
84 (95)
107(89)
110 (97)
not classified
10
f
56
51
93.7
15
83.6%
66.85
8 (86)
148 (97)
87 (97)
109 (93)
98 (81)
amnestic
11
m
43
14
208.3
15
35.6%
47.77
39 (30)
132 (74)
10 (21)
33 (27)
46 (16)
Wernicke
12
f
54
40
92.0
16
85.1%
44.51
43 (21)
81 (29)
21 (30)
37 (30)
65 (33)
Broca
f: female, m: male; PR: percent rank. AAT: Aachen Aphasia Test. AAT profile: average weighted score of all AAT subtests. 1 Percentage of correctly named objects across the three baseline testing runs
using the larger standardized set of 344 objects (correct = objects that were named 2 or 3 times correctly during the three runs)
13
Supplemental Table 2 Details of short- and long-term training effects for the three stimulation conditions
Training outcome (% correct above baseline)*
Overall training effect
Anodal
pooled across conditions
Short-
Long-
ID
and assessments
term
term
01
85.8
95.0
02
91.6
03
Cathodal
Short-
Long-
Pooled
term
term
95.0
95.0
98.0
95.0
90.0
92.5
90.2
93.0
93.0
04
91.7
90.0
05
91.8
06
Sham
Short-
Long-
Pooled
term
term
Pooled
67.0
82.5
93.0
67.0
80.0
97.0
85.0
91.0
93.0
90.0
91.5
93.0
90.0
85.0
87.5
92.0
88.0
90.0
97.0
93.5
90.0
97.0
93.5
88.0
88.0
88.0
95.0
88.0
91.5
90.0
98.0
94.0
90.0
90.0
90.0
89.7
95.0
88.0
91.5
88.0
88.0
88.0
85.0
94.0
89.5
07
91.7
97.0
90.0
93.5
94.0
90.0
92.0
94.0
85.0
89.5
08
15.5
43.0
42.0
42.5
0.0
0.0
0.0
0.0
8.0
4.0
09
95.5
98.0
97.0
97.5
98.0
95.0
96.5
92.0
93.0
92.5
10
92.5
93.0
93.0
93.0
98.0
85.0
91.5
98.0
88.0
93.0
11
69.0
80.0
75.0
77.5
67.0
60.0
63.5
65.0
67.0
66.0
12
91.5
97.0
87.0
92.0
100.0
94.0
97.0
88.0
83.0
85.5
* Training effects were assessed during confrontation naming (i.e., no language cues were provided)
14
Supplemental Table Training stimuli used during the three different stimulation conditions for each individual patient
Pat. 01
Pat. 02
Pat. 03
Pat. 04
Pat. 05
Locher
(hole punch)
Windmühle
(windmill)
Apfel
(apple)
Motorsäge
(motor saw)
Pinsel
(paint brush)
Globus
(globe)
Tiger
(tiger)
Gabel
(fork)
Fotoapparat
(camera)
Erdbeere
(strawberry)
Kanone
(cannon)
Liegestuhl
(deck chair)
Schaukel
(swing)
Kühltruhe
(freezer)
Hobel
(fad)
Schlittschuh
(skate)
Brokkoli
(broccoli)
Auge
(eye)
Staubsauger
(vacuum cleaner)
Wolle
(wool)
Gummibärchen
(gummi bear)
Mond
(moon)
Briefkasten
(mailbox)
Spüle
(sink)
Waffel
(waffle)
Fisch
(fish)
Kamm
(comb)
Ventilator
(ventilator)
Brennessel
(nettle)
Kaffeemaschine
(coffee machine)
Bohrer
(drill)
Marienkäfer
(ladybird)
Postkarte
(postcard)
Spielplatz
(playground)
Tulpe
(tulip)
Backform
(baking pan)
Geodreieck
(set square)
Zwieback
(rusk)
Laptop
(laptop)
Lippenstift
(lipstick)
Maiskolben
(corn)
Armbanduhr
(wrist watch)
Fächer
(fan)
Spülmittel
(soap)
Sandale
(sandal)
Delphin
(dolphin)
Tresor
(safe)
Diamant
(diamond)
Hamster
(hamster)
Frosch
(frog)
Toilettenpapier
(toilet paper)
Paprika
(paprika)
Zitrone
(lemon)
Lippenstift
(lipstick)
Kleeblatt
(cloverleaf)
Ameise
(ant)
Schildkröte
(turtle)
Sandale
(sandal)
Bischof
(bishop)
Fledermaus
(bat)
Ventilator
(ventilator)
Schokolade
(chocolate)
Spülmaschine
(dishwasher)
Spielplatz
(playground)
Glocke
(bell)
Fackel
(torch)
Megaphon
(megaphone)
Mücke
(mosquito)
Pilz
(mushroom)
Zange
(forceps)
Schlittschuh
(skate)
Walnuss
(walnut)
Blume
(flower)
Schildkröte
(turtle)
Mund
(mouth)
Hagebutte
(rose hip)
Teekanne
(teapot)
Kaffeekanne
(coffeepot)
Zahnbürste
(toothbrush)
Geodreieck
(set square)
Blitzer
(speed camera)
Schneemann
(snowman)
Palme
Auto
(car)
Kartoffeln
(potatoes)
Fotoapparat
(camera)
Wischer
(wiper)
Geweih
(antlers)
Knoblauch
(garlic)
Spiegelei
(fried egg)
Badeanzug
Luftmatratze
(airbed)
Erdbeere
(strawberry)
Melone
(melon)
Bonbon
(candy)
Segelboot
(sail boat)
Badeanzug
(bathing suit)
Obelisk
(obelisk)
Toaster
Garage
(garage)
Trichter
(cone)
Fackel
(torch)
Krawatte
(tie)
Heftzwecke
(staple)
Geodreieck
(set square)
Türklinke
(door handle)
Teelicht
Kirsche
(cherry)
Lenker
(handle bar)
Türklinke
(door handle)
Waschmaschine
(washer)
Tresor
(safe)
Esel
(donkey)
Tastatur
(keyboard)
Pfeil
Pat. 06
Pat. 07
Condition „anodal“
Schildkröte
Walnuss
(turtle)
(walnut)
Eichhörnchen
Gitarre
(squirrel)
(guitar)
Armbanduhr
Postkarte
(wrist watch)
(postcard)
Zahnbürste
Clown
(toothbrush)
(clown)
Raupe
Toilettenpapier
(caterpilar)
(toilet paper)
Erdbeere
Schmetterling
(strawberry)
(butterfly)
Geodreieck
Akkordeon
(set square)
(accordion)
Pelikan
Karussell
(pelican)
(carrousel)
Tiger
Ente
(tiger)
(duck)
Mausefalle
Boje
(mouse trap)
(buoy)
Sieb
Spülmittel
(strainer)
(soap)
Luftmatratze
Trichter
(airbed)
(cone)
Melone
Megaphon
(melon)
(megaphone)
Seerose
Kaffeemaschine
(water lily)
(coffee machine)
Hausschuhe
Stereoanlage
(slippers)
(stereo)
Condition „cathodal“
Mandarine
Wunderkerze
(tangerine)
(sparkler)
Lineal
Hubschrauber
(ruler)
(helicopter)
Ohrring
Mausefalle
(earring)
(mouse trap)
Eidechse
Trommel
(lizard)
(drum)
Weintrauben
Kabel
(grapes9
(cable)
Spiegelei
Waffel
(fried egg)
(waffle)
Blumenkohl
Pinguin
(cauliflower)
(penguin)
Luftpumpe
Schneebesen
Pat. 08
Pat. 09
Pat. 10
Pat. 11
Pat. 12
Metzger
(butcher)
Stern
(star)
Parfüm
(perfume)
Lippenstift
(lipstick)
Libelle
(dragonfly)
Federball
(shuttlecock)
Schlittschuh
(skate)
Messer
(knife)
Eidechse
(lizard)
Kühltruhe
(freezer)
Halskette
(necklace)
Erdbeere
(strawberry)
Bank
(bank)
Blei
(lead)
Möwe
(sea gull)
Ohrring
(earring)
Kochlöffel
(wooden spoon)
Krokodil
(crocodile)
Kastanie
(chestnut)
Hubschrauber
(helicopter)
Schlüssel
(key)
Windmühle
(windmill)
Kühltruhe
(freezer)
Gurke
(cucumber)
Kamm
(comb)
Laptop
(laptop)
Fotoapparat
(camera)
Motorrad
(motorbike)
Eidechse
(lizard)
Mikrowelle
(microwave)
Stereoanlage
(stereo)
Flugzeug
(plane)
Kühlschrank
(fridge)
Luftmatratze
(airbed)
Schuh
(shoe)
Badeanzug
(bathing suit)
Gorilla
(gorilla)
Laptop
(laptop)
Handschuh
(glove)
Zigarre
(cigar)
Topf
(pot)
Muschel
(shell)
Heftzwecke
(staple)
Gießkanne
(watering can)
Kaktus
(cactus)
Zitrone
(lemon)
Stempel
(stamp)
Akkordeon
(accordion)
Blasebalg
(bellows)
Palme
(palm)
Locher
(hole punch)
Toaster
(toaster)
Walnuss
(walnut)
Drucker
(printer)
Schaf
(sheep)
Hufeisen
(horseshoe)
Fliege
(fly)
Mandarine
(tangerine)
Erdbeere
(strawberry)
Kanone
(canon)
Mikroskop
(microscope)
Schlittschuh
(skate)
Schneemann
(snowman)
Bleistift
(pencil)
Mausefalle
(mouse trap)
Zebra
(zebra)
Fackel
(torch)
Stereoanlage
(stereo)
Kassette
(cassette)
Weihnachtsbaum
(christmas tree)
Bohrer
(drill)
Klarinette
(clarinette)
Blumenstrauß
(bouquet)
Obelisk
(obelisk)
Himbeere
(raspberry)
Luftballon
(balloon)
Feuerzeug
(lighter)
Pflaster
(band aid)
Regal
(shelf)
Schneebesen
(whisk)
Kochlöffel
(wooden spoon)
Mücke
(mosquito)
Liegestuhl
Türklinke
(door handle)
Sonnenuhr
(sun dial)
Blasebalg
(bellows)
Flaschenöffner
(bottle opener)
Sieb
(strainer)
Büroklammer
(paper clip)
Stethoskop
(stethoscope)
Wärmflasche
Paprika
(paprika)
Eule
(owl)
Elch
(elk)
Fledermaus
(bat)
Schere
(scissors)
Knoblauch
(garlic)
Leuchtturm
(lighthouse)
Kürbis
Zitrone
(lemon)
Stempel
(stamp)
Akkordeon
(accordion)
Blasebalg
(bellows)
Palme
(palm)
Locher
(hole punch)
Toaster
(toaster)
Walnuss
Motorsäge
(motor saw)
Nelke
(clove)
Karussell
(carrousel)
Lineal
(ruler)
Laptop
(laptop)
Rasierapparat
(razor)
Heftzwecke
(staple)
Wärmflasche
15
(palm)
Delphin
(dolphin)
Walnuss
(walnut)
Armband
(wristband)
Sonnenblume
(sunflower)
Fledermaus
(bat)
Brennessel
(nettle)
Wiege
(cradle)
(bathing suit)
Taschenlampe
(flashlight)
Mücke
(mosquito)
Weintrauben
(grapes)
Klarinette
(clarinette)
Wappen
(crest)
Weihnachtsbaum
(christmas tree)
Sonnenblume
(sunflower)
(toaster)
Geweih
(antlers)
Trommel
(drum)
Möwe
(seagull)
Trichter
(cone)
Kirche
(church)
Pinguin
(penguin)
Schmetterling
(butterfly)
(tealight)
Heidelbeere
(blueberry)
Brokkoli
(broccoli)
Geodreieck
(set square)
Zahnpasta
(tooth paste)
Drachen
(kite)
Schlittschuh
(skate)
Megaphon
(megaphone)
(arrow)
Blasebalg
(bellows)
Seerose
(water lily)
Hirsch
(deer)
Zwiebel
(onion)
Deckel
(lid)
Orgel
(organ)
Zahnbürste
(tooth brush)
Wunderkerze
(sparkler)
Nilpferd
(hippo)
Schokolade
(chocolate)
Kirsche
(cherry)
Fernseher
(TV set)
Bohrer
(drill)
Feuerwerk
(fireworks)
Kaffeebohne
(coffee bean)
Diamant
(diamond)
Heftzwecke
(staple)
Wischer
(wiper)
Stereoanlage
(stereo)
Buch
(book)
Harke
(rake)
Schildkröte
(turtle)
Stethoskop
(stethoscope)
Melone
(melon)
Igel
(hedgehog)
Sandale
(sandal)
Zigarre
(cigar)
Schneebesen
(whisk)
Türklinke
(door handle)
Eidechse
(lizard)
Geodreieck
(set square)
Spülmaschine
(dishwasher)
Trommel
(drum)
Blitz
(lightning)
Bügeleisen
(iron)
Armband
(wristband)
Feuerzeug
(lighter)
Schneemann
(snowman)
Zahnbürste
(toothbrush)
Mausefalle
(mouse trap)
Perle
(pearl)
Blasebalg
(bellows)
Mond
(moon)
Luftballon
(balloon)
Delphin
(dolphin)
Kastanie
(chestnut)
Brombeere
(blackberry)
Klarinette
(clarinette)
Krawatte
(tie)
Boje
(buoy)
Wappen
(crest)
Mikroskop
(microscope)
Weihnachtsbaum
(christmas tree)
Brombeere
(blackberry)
Gitarre
(guitar)
Möhre
(carrot)
Globus
(globe)
Esel
(donkey)
Ventilator
(ventilator)
Specht
(woodpecker)
Knoblauch
(garlic)
Eichhörnchen
(squirrel)
Petersilie
(parsley)
Tacker
(stapler)
Heidelbeere
(blueberry)
Schloss
(lock)
Kartoffeln
(potatoes)
Zeitung
(newspaper)
Diamant
(diamond)
Katze
(cat)
Laptop
(laptop)
Parfüm
(perfume)
Ohrring
(earring)
Topflappen
(oven cloth)
Weintrauben
(grapes)
Streichholz
(matches)
Kleeblatt
(cloverleaf)
Ente
(duck)
Stethoskop
(stethoscope)
Zitronenpresse
(lemon squeezer)
Gebiss
(denture)
Leuchtturm
(lighthouse)
(air pump)
(whisk)
Büroklammer
Gorilla
(paper clip)
(gorilla)
Blasebalg
Stethoskop
(bellows)
(stethoscope)
Sandale
Topflappen
(sandal)
(oven cloth)
Gummistiefel
Bonbon
(rubber boots)
(candy)
Pinguin
Keks
(penguin)
(cracker)
Akkordeon
Bierdeckel
(accordion)
(beer coaster)
Schuh
Kartoffeln
(shoe)
(potatoes)
Condition „sham“
Wärmflasche
Luftmatratze
(hot-water bag)
(airbed)
Bügeleisen
Blitzer
(iron)
(speed camera)
Bierdeckel
Kleeblatt
(beer coaster)
(cloverleaf)
Papagei
Kanone
(parrot)
(cannon)
Luftballon
Spiegelei
(balloon)
(fried egg)
Postkarte
Teekanne
(postcard)
(teapot)
Megaphon
Nelke
(megaphone)
(clove)
Spülmittel
Roboter
(soap)
(robot)
Schwan
Wappen
(swan)
(crest)
Mülltonne
Hausschuhe
(trash can)
(slippers)
Blumenstrauß
Bäckerei
(bouquet)
(bakery)
Zigarette
Zitronenpresse
(cigarette)
(lemon press)
Elefant
Zebra
(eplephant)
(zebra)
Hagebutte
Waschlappen
(rose hip)
(wash cloth)
Schmetterling
Himbeere
(butterfly)
(raspberry)
(deck chair)
Storch
(stork)
Flagge
(flag)
Diamant
(diamond)
Fernseher
(TV set)
Flagge
(flag)
Muschel
(shell)
Bett
(bed)
(hot-water bag)
Wunderkerze
(sparkler)
Ziegel
(tile)
Motorsäge
(motor saw)
Armbanduhr
(wrist watch)
Gurke
(cucumber)
Hufeisen
(horseshoe)
Kaffeemaschine
(coffee machine)
(pumpkin)
Mülltonne
(trash can)
Toilette
(toilet)
Briefkasten
(mailbox)
Krokodil
(crocodile)
Haselnuss
(hazelnut)
Schlittschuh
(skate)
Hahn
(rooster)
(walnut)
Drucker
(printer)
Schaf
(sheep)
Hufeisen
(horseshoe)
Fliege
(mosquito)
Mandarine
(tangerine)
Erdbeere
(strawberry)
Kanone
(canon)
(hot-water bag)
Mikrowelle
(microwave)
Schlange
(snake)
Taschenlampe
(flashlight)
Krawatte
(tie)
Schlüssel
(key)
Zwieback
(rusk)
Büroklammer
(paper clip)
Mund
(mouth)
Kirsche
(cherry)
Specht
(woodpecker)
Wasserhahn
(faucet)
Bagger
(digger)
Eichhörnchen
(squirrel)
Ameise
(ant)
Elefant
(elephant)
Perle
(pearl)
Fliege
(fly)
Zigarre
(cigar)
Möhre
(carrot)
Nase
(nose)
Baum
(tree)
Feuerwerk
(fireworks)
Sonnenblume
(sunflower)
Akkordeon
(accordion)
Bleistift
(pencil)
Geodreieck
(set square)
Feuerzeug
(lighter)
Kaffeebohne
(coffee bean)
Klarinette
(clarinette)
Mikroskop
(microscope)
Schwan
(swan)
Stereoanlage
(stereo)
Topflappen
(oven cloth)
Walnuss
(walnut)
Eichhörnchen
(squirrel)
Globus
(globe)
Zeitung
(newspaper)
Klarinette
(clarinette)
Feuerzeug
(lighter)
Hirsch
(deer)
Armband
(wristband)
Papagei
(parrot)
Kutsche
(carriage)
Kassette
(cassette)
Luftballon
(balloon)
Specht
(woodpecker)
Nilpferd
(hippo)
Schmetterling
(butterfly)
Sanduhr
(hourglass)
Kühltruhe
(freezer)
Zylinder
(cylinder)
Hagebutte
(rose hip)
Trommel
(drum)
Tresor
(safe)
Leuchtturm
(lighthouse)
Marienkäfer
(lady bird)
Wasserhahn
(faucet)
Bäckerei
(bakery)
Perle
(pearl)
Tiger
(tiger)
Gitarre
(guitar)
Himbeere
(raspberry)
Bierdeckel
(beer coaster)
Regenschirm
(umbrella)
Elefant
(elephant)
Kartoffeln
(potatoes)
Delphin
(dolphin)
Muschel
(shell)
Megaphon
(megaphone)
Weintrauben
(grapes)
Boje
(buoy)
Kühltruhe
(freezer)
Blasebalg
(bellows)
Mandarine
(tangerine)
Kanone
(cannon)
Schildkröte
(turtle)
Schneebesen
(whisk)
Pelikan
(pelican)
Stethoskop
(stethoscope)
Drucker
(printer)
Haselnuss
(hazelnut)
Zitrone
(lemon)
16
Supplemental Figure 1 A Lesion overlay plot including 11 patients (without #08); (a) + (b): coronal and saggital overviews; (c) series of axial
slices; color bar indicates overlap of lesions.
17
Supplemental Figure 1 B Axial slices of T1 weighted MRI scans acquired in the context of the present study illustrating lesion location and size
in 10 of the patients.
18
Supplemental Figure 1 C Shows lesion location in the two remaining patients: Pat. 05: CT image acquired in the chronic stage; Pat08: T2
weighted MRI scan acquired in the post-acute stage after stroke.
19
30
Stroke 日本語版 Vol. 6, No. 3
Abstract
失名詞症に対する短期訓練と脳電気刺激
Short-Term Anomia Training and Electrical Brain Stimulation
Agnes Flöel, MD1,2; Marcus Meinzer, PhD1; Robert Kirstein2; Sarah Nijhof2; Michael Deppe, PhD2; Stefan
Knecht, MD2; Caterina Breitenstein, PhD2
1
2
Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany;
Department of Neurology, University of Münster, Münster, Germany
結果：すべての訓練条件において呼称能力が有意に改善し，
訓練終了後 2 週間以上にわたって改善が維持された。経頭
蓋陽極直流電気刺激によって，全般的な訓練効果が偽刺激
に比べて有意に向上した。ベースラインの呼称能力は，経
頭蓋陽極直流電気刺激の効果の有意な予測因子であった。
結論：非言語半球への経頭蓋陽極直流電気刺激により，慢
性期失語症の言語訓練の効果を改善することができる。
臨床試験登録：URL：www.clinicaltrials.gov/ 固有識別子：
NCT00822068
背景および目的：慢性期失語症に対する言語訓練の成功率
ははかばかしくない。脳電気刺激は，治療効果を高めるた
めの有望な方法の 1 つであると考えられる。
方法：無作為二重盲検偽処置対照クロスオーバー試験にお
いて，右側頭−頭頂皮質への経頭蓋陽極直流電気刺激と経
頭蓋陰極直流電気刺激および偽刺激とを比較し，陽極直流
電気刺激によって，失名詞症に対する短期集中訓練の成功
率が改善するか否かを検討した。脳卒中後の慢性期失語症
患者 12 例を研究に組み入れた。訓練直後および 2 週後に，
呼称訓練の結果を評価した。
Stroke 2011; 42: 2065-2067
ベースライン
A
訓練1
訓練2
訓練3
セット1
セット2
セット3
＋陽極刺激
＋陰極刺激
＋偽刺激
時間
3×344枚の画像を呈示
2，
3を選択
セット1，
（それぞれ15種類の対象物）
訓練直後
訓練から
2週間後
1ブロック＝画像呼称課題を60回試行
（15種類の対象物×画像トークン4枚）
B
ブロック1
0分
ブロック6
60分
stroke6-3.indb 30
ブロック2
ブロック3
ブロック4
tDCS
（20分）
休憩15分
ブロック7
ブロック9
tDCS
（20分）
ブロック8
C
ブロック5
60分
ブロック10
120分
刺激
（1mA）
2×20分/日
A：3 回の訓練・刺激セッションを被
験者に実施した。訓練直後と 2 週間
後に検査を行った。B：訓練セッショ
図 1 ン。C： 頭 部 の 経 頭 蓋 直 流 電 気 刺 激
（ tDCS ）部位を赤色の点で示す（ 黄色
の点は標準的な 10 ∼ 20 法による
脳波測定部位を示す ）
。
11.12.26 1:37:00 PM