Influence of Immediate and Long Term Effects of Repetitive Transcranial Magnetic Stimulation Combined with Speech Therapy on Post Stroke Nonfluent
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 10
Abstract
Background: A high proportion of patients who have suffered a stroke also suffer from aphasia. The aim of this work was to determine and investigate immediate and long term effects of repetitive transcranial magnetic stimulation combined with speech and language exercise therapy on non fluent motor aphasia (Broca's aphasia) in chronic cerebrovascular stroke. Methods: Forty chronic cerebrovascular stroke patients represented the sample of the study. Their age ranged from 45 to 60 years. The patients were assigned randomly into two equal groups; study group (G1) and control group (G2). The patients in both groups received the same medical and physical care during treatment period to avoid any complications. The study group treated by selected speech exercises combined with rTMS. Different domains of speech function (repetition, reading, naming, writing, comprehension and spontaneous speech) were assessed by the Arabic translated form of the modified Chesher test and Token test of Aachen aphasia test (AAT). Power of stimulation intensity of rTMS (represents 90% of the resting motor threshold that recorded from contraction of the first dorsal interosseus of the unaffected hand) were measured pre, post and after three months of the end of the treatment to determine level of brain excitability. The results: At the end of the treatment there was a significant improvement in all domains in (G1) of the Arabic translated form of the modified Chesher test. In the control group (G2) there was a change in total score of the Arabic translated form of the modified Chesher test in approximately all domains but not reach www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Moshera H. Darwish et al JMSCR Volume 02 Issue 10 October 2014 Page 2488 JMSCR Volume||2||Issue||10||Page 2487-2504||October-2014 2014 to significance level (P<0.05) except auditory comprehension and pantomime there was a significant increase (P>5). Comparison of mean values of all domains of (G1) and (G2) post treatment indicate significance improvement of all different domains measured by clinical tests or rTMS in (G1). A significant decrease in the mean value of power intensity of rTMS post treatment in (G1) was observed (P<0.05). There was a Strong negative correlation between improvements in total score of the Arabic translated form of the modified Chesher test and the decrease of the mean values of power intensity of rTMS in (G1). Conclusion: Speech exercises combined with rTMS permit the mechanisms of transcortical disinhibition to enhance language function in chronic non- fluent aphasia post stroke patients. Low frequency rTMS delivered over Broca's area could improve language by enhancing long-term potentiation and synaptic plasticity within the stimulated areas involved in language network.
Authors and Affiliations
Moshera H. Darwish
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