TEXTOS SOBRE TIPOS DE TERAPIAS MAS RECIENTES

Stroke. 2014 Dec;45(12):3656-62. doi: 10.1161/STROKEAHA.114.007058. Epub 2014 Nov 6.

Efficacy of synchronous verbal training during repetitive transcranial magnetic
stimulation in patients with chronic aphasia.
Wang CP1, Hsieh CY1, Tsai PY2, Wang CT1, Lin FG1, Chan RC1.
Author information
Abstract
BACKGROUND AND PURPOSE:
Although multiple studies have suggested that repetitive transcranial magnetic stimulation
(rTMS) may facilitate recovery after stroke, the efficacy of synchronous speech therapy
integrated with an rTMS protocol has yet to be determined. We investigated language
responses to this strategy and determined the longevity of the resulting therapeutic outcomes.
METHODS:
Forty-five patients with stroke who presented with nonfluent aphasia were randomly assigned to
the TMSsyn group and underwent synchronous picture-naming training together with
contralesional 1 Hz-rTMS for 10 daily sessions. The TMSsub group underwent subsequent
picture-naming activity after the primed 1 Hz-rTMS, and the TMSsham group received
concurrent naming task along with the sham 1 Hz-rTMS. The Concise Chinese Aphasia test and
the picture-naming test were performed before, immediately, and after 3 months of the
intervention.
RESULTS:
TMSsyn showed significantly superior results in Concise Chinese Aphasia test score (P<0.001),
expression and description subtests (P<0.001), and action (P=0.02) and object naming activity
(P=0.008); the superior results lasted for 3 months (P=0.005), in comparison with the TMSsub
and TMSsham groups.
CONCLUSIONS:
We established a real-time model that involved implementing verbal tasks together with the
rTMS protocol. Our results confirmed that the strategy yielded favorable outcomes that were of
considerable longevity. The results also indicated that the rTMS protocol and language training
can be combined to achieve outcomes superior to those obtained when used separately.

Brain Lang. 2014 Sep;136:1-7. doi: 10.1016/j.bandl.2014.03.011. Epub 2014 Jul 18.

Intensive therapy induces contralateral white matter changes in chronic stroke patients with
Broca's aphasia.

Wan CY1, Zheng X1, Marchina S1, Norton A1, Schlaug G2.

Author information

Abstract

Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and
nonfluent aphasia underwent diffusion tensor imaging and language testing before and after
receiving 15 weeks of an intensive intonation-based speech therapy. This treated patient group
was compared to an untreated patient group (n=9) scanned twice over a similar time period.
Our results showed that the treated group, but not the untreated group, had reductions in
fractional anisotropy in the white matter underlying the right inferior frontal gyrus (IFG, pars
opercularis and pars triangularis), the right posterior superior temporal gyrus, and the right
posterior cingulum. Furthermore, we found that greater improvements in speech production
were associated with greater reductions in FA in the right IFG (pars opercularis). Thus, our
findings showed that an intensive rehabilitation program for patients with nonfluent aphasia led
to structural changes in the right hemisphere, which correlated with improvements in speech
production.

KEYWORDS:

Contralateral hemisphere; Diffusion-tensor imaging; Melodic intonation therapy; Plasticity;

Stroke; Training

LI Wen-bing and ZHANG Tong. Mechanims of improved speech production by voice cues
in nonfluent aphasia patients. http://www.ncbi.nlm.nih.gov/pubmed/24342331

Keywords
nonfluent aphasia; idioms; speech production
Abstract
Language training for nonfluent aphasia (NFA) patients may increase their verbal expression of
unfamiliar words. Some therapies aimed at the improvement of cognitive functions can facilitate
the recovery of NFA patients damaged linguistic functions. Some studies have shown that with
music cues NFA patients could fluently sing their familiar songs but could not read the lyrics,
consistent with studies of proverbs and prayer.1Our previous research has shown that highly
related voice cues can improve NFA patients verbal expression. 2These results indicate that the
improvement of NFA patients speech production may benefit from regaining the extraction of
phonological encoding that has already been preserved in memory, rather than re-study of the
language.
According to the Dual Route Model,there are two routes for the processing of Chinese
characters, the grapheme-phoneme route and the grapheme-semanteme-phoneme route. That
is to say, the phonological processing is primary for verbal expression. If the improvement of
speech production by voice cues is related with the phonological processing which is consistent
with the Dual Route Model, NFA patients should be able to selectively extract the phonological
encoding induced by voice cues through the grapheme-phoneme route, but this is contrary to
our results. Therefore, speech production induced by voice cues may have nothing to do with
the phonological processing, and there may exist another speech production route other than
the Dual Route Model. This study aimed to explore the mechanism in post-stroke NFA patients.