Document Type : Original Article
Authors
1 1Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
2 Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara
3 Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
4 Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia
Abstract
Background: Aphasia is a major cause of long-term disability in post-stroke patients. Non-invasive brain stimulation, particularly transcranial direct current stimulation (tDCS), has shown promise in enhancing language recovery. However, evidence from Indonesia remains scarce. To evaluate the effects of tDCS on language recovery in chronic post-stroke aphasia (PSA).
Methods: This quasi-experimental study included 30 patients with chronic PSA, divided into 2 groups: 15 received 5 sessions of tDCS combined with language training, while 15 underwent language training alone. Language abilities were assessed using the Tes Afasia untuk Diagnosis Informasi dan Rehabilitasi (TADIR) or Aphasia Test for Diagnostic Information and Rehabilitation at baseline, post-therapy, and 2 weeks post-therapy. Statistical analysis was conducted using the Friedman test.
Results: Participants (93.3% male) had a median age of 56 years (range: 33-65 years). The tDCS group showed significant improvements in TADIR subtests, including verbal fluency, word naming, speech rate, verbal comprehension, and writing (P < 0.05). The control group showed improvements in fewer subtests, namely verbal fluency, word naming, and repetition.
Conclusion: Combining tDCS with language training may enhance recovery in specific language domains, notably writing, among patients with chronic PSA. However, most between-group comparisons did not reach statistical significance, and findings should be interpreted as exploratory. Larger controlled trials are needed to establish the efficacy and clinical relevance of tDCS in aphasia rehabilitation.
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Main Subjects
- The National Aphasia Association. What is Aphasia? [Online]. [Updated: 24 Nov 2023]. https://aphasia.org/what-is-aphasia/.
- Le H, Lui F, Lui MY. Aphasia. [Updated: 2024 Oct 29]. In: StatPearls [Online]. Treasure Island, FL: StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559315
- El-Tallawy HN, Gad AHES, Ali AM, Abd-El-Hakim MN. Relative frequency and prognosis of vascular aphasia (follow-up at 3 months) in the neurology department of assiut university hospital. Egypt J Neurol Psychiatry Neurosurg 2019; 55: 41.
- Frederick A, Jacobs M, Adams-Mitchell CJ, Ellis C. The global rate of post-stroke aphasia. Perspect ASHA Spec Interest Groups 2022; 7(5): 1567-72.
- Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23(2): 183-201.
- Adina S, Strilciuc S, Gherghel N, Cozma A, Cristian A, Silvina I, et al. Aphasia after acute ischemic stroke: epidemiology and impact on tertiary care resources. Balneo PRM Res J 2021; 12(4): 376-80.
- Grönberg A, Henriksson I, Stenman M, Lindgren AG. Incidence of Aphasia in Ischemic Stroke. Neuroepidemiology 2022; 56(3): 174-82.
- Sul B, Kim JS, Hong BY, Lee KB, Hwang WS, Kim YK, et al. The Prognosis and Recovery of Aphasia Related to Stroke Lesion. Ann Rehabil Med 2016; 40(5): 786-93.
- Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, et al. Novel advances to post-stroke aphasia pharmacology and rehabilitation. J Clin Med 2021; 10(17): 3778.
- The REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) Collaborators. Predictors of poststroke aphasia recovery: A systematic review-informed individual participant data meta-analysis. Stroke 2021; 52(5): 1778-87.
- Norise C, Hamilton RH. Non-invasive brain stimulation in the treatment of post-stroke and neurodegenerative aphasia: parallels, differences, and lessons learned. Front Hum Neurosci 2017; 10: 675.
- Biou E, Cassoudesalle H, Cogné M, Sibon I, De Gabory I, Dehail P, et al. Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review. Ann Phys Rehabil Med 2019; 62(2): 104-21.
- Polanowska KE, Leśniak M, Seniów JB, Członkowska A. No effects of anodal transcranial direct stimulation on language abilities in early rehabilitation of post-stroke aphasic patients. Neurol Neurochir Pol 2013; 47(5): 414-22.
- Spielmann K, Van De Sandt-Koenderman WME, Heijenbrok-Kal MH, Ribbers GM. Transcranial direct current stimulation does not improve language outcome in subacute poststroke aphasia. Stroke 2018; 49(4): 1018-20.
- Cheng W, Li Y, Cheng B, Chen Y, Chen Z, Cui L, et al. Effects of transcranial direct current stimulation over the right hemisphere on naming ability in patients with poststroke aphasia: A meta-analysis. J Neurolinguistics 2021; 58: 100986.
- Dharmaperwira-Prins RI. The indonesian aphasia test ‘TADIR’: Tes afasia untuk diagnose informasi rehabilitasi. Asia Pac J Speech Lang Hear 2000; 5(3): 143-7.
- Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke 2010; 41(6): 1229-36.
- Wu D, Wang J, Yuan Y. Effects of transcranial direct current stimulation on naming and cortical excitability in stroke patients with aphasia. Neurosci Lett 2015; 589: 115-20.
- Pestalozzi MI, Di Pietro M, Martins Gaytanidis C, Spierer L, Schnider A, Chouiter L, et al. Effects of Prefrontal Transcranial Direct Current Stimulation on Lexical Access in Chronic Poststroke Aphasia. Neurorehabil Neural Repair 2018; 32(10): 913-23.
- Marangolo P, Fiori V, Calpagnano MA, Campana S, Razzano C, Caltagirone C, et al. tDCS over the left inferior frontal cortex improves speech production in aphasia. Front Hum Neurosci 2013; 7: 539.
- De Aguiar V, Bastiaanse R, Capasso R, Gandolfi M, Smania N, Rossi G, et al. Can tDCS enhance item-specific effects and generalization after linguistically motivated aphasia therapy for verbs? Front Behav Neurosci 2015; 9: 190.
- Elsner B, Kugler J, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2020; 17(1): 88.
- Klebic J, Salihovic N, Softic R, Salihovic D. Aphasia disorders outcome after stroke. Med Arh 2011; 65(5): 283-6.
- Lifshitz-Ben-Basat A, Taitelbaum-Swead R, Fostick L. Speech perception following transcranial direct current stimulation (tDCS) over left superior temporal gyrus (STG) (including Wernicke's area) versus inferior frontal gyrus (IFG) (including Broca's area). Neuropsychologia 2024; 202: 108959.
- Cummine J, Villarena M, Onysyk T, Devlin JT. A study of null effects for the use of transcranial direct current stimulation (tDCS) in adults with and without reading impairment. Neurobiol Lang (Camb) 2020; 1(4): 434-51.
- Fiori V, Cipollari S, Di Paola M, Razzano C, Caltagirone C, Marangolo P. tDCS stimulation segregates words in the brain: evidence from aphasia. Front Hum Neurosci 2013; 7: 269.
- Zettin M, Bondesan C, Nada G, Varini M, Dimitri D. Transcranial direct-current stimulation and behavioral training, a promising tool for a tailor-made post-stroke aphasia rehabilitation: A review. Front Hum Neurosci 2021; 15: 742136.
- Frase L, Mertens L, Krahl A, Bhatia K, Feige B, Heinrich SP, et al. Transcranial direct current stimulation induces long-term potentiation-like plasticity in the human visual cortex. Transl Psychiatry 2021; 11(1): 17.
- Volpato C, Cavinato M, Piccione F, Garzon M, Meneghello F, Birbaumer N. Transcranial direct current stimulation (tDCS) of broca's area in chronic aphasia: A controlled outcome study. Behav Brain Res 2013; 247: 211-6.
- Silva FRD, Mac-Kay A, Chao JC, Santos MDD, Gagliadi RJ. Transcranial direct current stimulation: a study on naming performance in aphasic individuals. Codas 2018; 30(5): e20170242.
- Santos MDD, Cavenaghi VB, Mac-Kay A, Serafim V, Venturi A, Truong DQ, et al. Non-invasive brain stimulation and computational models in post-stroke aphasic patients: single session of transcranial magnetic stimulation and transcranial direct current stimulation. A randomized clinical trial. Sao Paulo Med J 2017; 135(5): 475-80.