Aphasia Neuroplasticity Review

Darkow et al. (2017)

Reference

AuthorsDarkow R, Martin A, Würtz A, Flöel A, Meinzer M
TitleTranscranial direct current stimulation effects on neural processing in post-stroke aphasia
ReferenceHum Brain Mapp 2017; 38: 1518-1531
PMID27859982
DOI10.1002/hbm.23469

Participants

LanguageGerman
Inclusion criteriaL hand motor area spared; mild aphasia
Number of individuals with aphasia16
Number of control participants16
Were any of the participants included in any previous studies?No
Is age reported for patients and controls, and matched?Yes (mean 56.7 ± 10.1 years)
Is sex reported for patients and controls, and matched?Yes (males: 10; females: 6)
Is handedness reported for patients and controls, and matched?Yes (right: 16; left: 0)
Is time post stroke onset reported and appropriate to the study design?Yes (mean 54.3 ± 45.3 months, range 12-169 months)
To what extent is the nature of aphasia characterized?Comprehensive battery
Language evaluationAAT
Aphasia severityMild
Aphasia typeNot stated
First stroke only?Not stated
Stroke typeNot stated
To what extent is the lesion distribution characterized?Lesion overlay
Lesion extentRange 9.7-165.1 cc
Lesion locationL MCA not including hand motor area
Participants notes

Imaging

ModalityfMRI
Is the study cross-sectional or longitudinal?Longitudinal—chronic treatment
If longitudinal, at what time point(s) were imaging data acquired?T1/T2: chronic; tDCS and sham sessions in randomized order
If longitudinal, was there any intervention between the time points?
Is the scanner described?Yes (Siemens Trio 3 Tesla)
Is the timing of stimulus presentation and image acquisition clearly described and appropriate?Yes
Design typeEvent-related
Total images acquired100
Are the imaging acquisition parameters, including coverage, adequately described and appropriate?Yes (whole brain)
Is preprocessing and intrasubject coregistration adequately described and appropriate?Yes
Is first level model fitting adequately described and appropriate?Yes
Is intersubject normalization adequately described and appropriate?Yes
Imaging notessparse sampling

Conditions

Are the conditions clearly described?Yes
ConditionResponse typeRepetitionsAll groups could do?All individuals could do?
picture namingWord (overt)80YesYes
restNone20N/AN/A
Conditions notes

Contrasts

Are the contrasts clearly described?Yes

Contrast 1: picture naming vs rest

Language conditionPicture naming
Control conditionRest
Are the conditions matched for visual demands?No
Are the conditions matched for auditory demands?No
Are the conditions matched for motor demands?No
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Is reaction time matched between the language and control tasks for all relevant groups?N/A, tasks not comparable
Behavioral data notes
Are control data reported in this paper or another that is referenced?No
Does the contrast selectively activate plausible relevant language regions in the control group?Unknown
Are activations lateralized in the control data?Unknown
Control activation notes
Contrast notes

Analyses

Are the analyses clearly described?Yes

Voxelwise analysis 1

First level contrastPicture naming vs rest
Analysis classCross-sectional between two groups with aphasia
Group(s)Aphasia after tDCS (n = 16) vs aphasia after sham stimulation (n = 16); same patients, order counterbalanced, repeated measures
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (no behavioral difference)
Is accuracy matched across the second level contrast?Yes, matched
Is reaction time matched across the second level contrast?Yes, matched
Behavioral data notes
Type of analysisVoxelwise
Search volumeWhole brain
Correction for multiple comparisonsClusterwise correction with with GRFT and stringent voxelwise p
SoftwareSPM8
Voxelwise p.001
Cluster extentBased on GRFT
Statistical detailsRepeated measures
Findings↓ L insula
↓ L anterior cingulate
↓ R occipital
↓ R anterior cingulate
Findings notes

ROI analysis 1

First level contrastPicture naming vs rest
Analysis classCross-sectional aphasia vs control
Group(s)Aphasia after sham stimulation (n = 16) vs control
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Appear similar
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notesPatients named > 90% correctly in all sessions; control RT not reported
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?3
What are the ROI(s)?(1) bilateral anterior cingulate; (2) L insula; (3) R lingual gyrus
How are the ROI(s) defined?Regions that were less active in patients with tDCS vs sham
Correction for multiple comparisonsNo correction
Statistical detailsCircular because ROIs defined in one group
Findings↑ L insula
↑ L anterior cingulate
↑ R anterior cingulate
Findings notes

ROI analysis 2

First level contrastPicture naming vs rest
Analysis classCross-sectional aphasia vs control
Group(s)Aphasia after tDCS (n = 16) vs control
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Appear similar
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notesPatients named > 90% correctly in all sessions; control RT not reported
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?3
What are the ROI(s)?(1) bilateral anterior cingulate; (2) L insula; (3) R lingual gyrus
How are the ROI(s) defined?Regions that were less active in patients with tDCS vs sham
Correction for multiple comparisonsNo correction
Statistical detailsCircular because ROIs defined in one group
FindingsNone
Findings notes

Complex analysis 1

First level contrastPicture naming vs rest
Analysis classCross-sectional between two groups with aphasia
Group(s)Aphasia after tDCS (n = 16) vs aphasia after sham stimulation (n = 16); same patients, order counterbalanced, repeated measures
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (no behavioral difference)
Is accuracy matched across the second level contrast?Yes, matched
Is reaction time matched across the second level contrast?Yes, matched
Behavioral data notes
Type of analysisComplex
Statistical detailsICA was used to derive three task-relevant components: language, motor and visual. Thresholding of the functional maps is not described, but they appear to reflect coherent components of a picture naming network. These components were compared between stimulation conditions in terms of mean activity and power in three frequency bins. It should be noted that the language component is left-lateralized, unlike the model-based picture naming contrast.
FindingsOther
Findings notesActivity in the language component was greater in the tDCS condition. In the frequency domain, the tDCS condition showed reduced power in the highest frequency bin, and increased power in the lowest frequency bin.

Complex analysis 2

First level contrastPicture naming vs rest
Analysis classCross-sectional aphasia vs control
Group(s)Aphasia after sham stimulation (n = 16) vs control
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisComplex
Statistical detailsICA was used to derive three task-relevant components: language, motor and visual. Thresholding of the functional maps is not described, but they appear to reflect coherent components of a picture naming network. These components were compared between stimulation conditions in terms of mean activity and power in three frequency bins. It should be noted that the language component is left-lateralized, unlike the model-based picture naming contrast.
FindingsOther
Findings notesMean activity of these components did not differ between patients and controls. However, patients showed increased power in the middle frequency bin of the visual component.

Complex analysis 3

First level contrastPicture naming vs rest
Analysis classCross-sectional aphasia vs control
Group(s)Aphasia after tDCS (n = 16) vs control
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisComplex
Statistical detailsICA was used to derive three task-relevant components: language, motor and visual. Thresholding of the functional maps is not described, but they appear to reflect coherent components of a picture naming network. These components were compared between stimulation conditions in terms of mean activity and power in three frequency bins. It should be noted that the language component is left-lateralized, unlike the model-based picture naming contrast.
FindingsNone
Findings notes

Notes

Excluded analyses