Electrical Field Guided TMS and Constraint Induced Language Therapy to TreatPost-Stroke Aphasia in the Subacute Stage

Project Summary Transcranial Magnetic Stimulation (TMS), sometimes in conjunction with Speech-Language Therapy, has been demonstrated to improve language function in subjects with chronic aphasia in a number of small studies. Several lines of evidence suggest that it is more effective when provided in the subacute stage after stroke but

its efficacy in this setting has not been adequately assessed. We propose to study the effects of continuous Theta Burst Stimulation (a type of TMS) combined with a modified form of Constraint Induced Language Therapy (mCILT) in 63 subjects with subacute aphasia. Subjects will be randomized in a 2:1 ratio to cTBS with

mCILT or sham cTBS with mCILT. After pre-treatment evaluation, subjects will receive 10 days of treatment; post-treatment evaluations will be performed 3-5 days and again at 4 months after the completion of treatment. We will use electrical field modelling to personalize stimulation intensity for each subject. Change from

baseline in the Western Aphasia Battery-Revised Aphasia Quotient at 4 months after the end of treatment will serve as the primary outcome measure. A secondary aim is to identify anatomic and behavioral predictors of response to treatment. Finally, a third aim is to identify the mechanism underlying the beneficial effect of the

treatment on brain organization using network neuroscience approaches. We will identify changes in the strengths of connections between nodes in the language network to address specific hypotheses regarding the effects of cTBS and mCILT on brain organization that are associated with beneficial response to treatment.