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      Cerebellar neuromodulation improves naming in post-stroke aphasia

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          Abstract

          Transcranial direct current stimulation has been shown to increase the efficiency of language therapy in chronic aphasia; however, to date, an optimal stimulation site has not been identified. We investigated whether neuromodulation of the right cerebellum can improve naming skills in chronic aphasia. Using a randomized, double-blind, sham-controlled, within-subject crossover study design, participants received anodal cerebellar stimulation ( n = 12) or cathodal cerebellar stimulation ( n = 12) + computerized aphasia therapy then sham + computerized aphasia therapy, or the opposite order. There was no significant effect of treatment (cerebellar stimulation versus sham) for trained naming. However, there was a significant order x treatment interaction, indicating that cerebellar stimulation was more effective than sham immediately post-treatment for participants who received cerebellar stimulation in the first phase. There was a significant effect of treatment (cerebellar stimulation versus sham) for untrained naming immediately post-treatment and the significant improvement in untrained naming was maintained at two months post-treatment. Greater gains in naming (relative to sham) were noted for participants receiving cathodal stimulation for both trained and untrained items. Thus, our study provides evidence that repetitive cerebellar transcranial direct stimulation combined with computerized aphasia treatment can improve picture naming in chronic post-stroke aphasia. These findings suggest that the right cerebellum might be an optimal stimulation site for aphasia rehabilitation and this could be an answer to handle heterogeneous participants who vary in their size and site of left hemisphere lesions.

          Abstract

          Using a randomized, double-blind, sham-controlled, within-subject crossover study design, Sebastian et al. investigated whether cerebellar transcranial direct current stimulation combined with computerized aphasia treatment can improve picture naming in chronic aphasia. Results indicate significant improvement in untrained naming and trained naming (only for participants who received stimulation first) compared to sham.

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          A technical guide to tDCS, and related non-invasive brain stimulation tools.

          Transcranial electrical stimulation (tES), including transcranial direct and alternating current stimulation (tDCS, tACS) are non-invasive brain stimulation techniques increasingly used for modulation of central nervous system excitability in humans. Here we address methodological issues required for tES application. This review covers technical aspects of tES, as well as applications like exploration of brain physiology, modelling approaches, tES in cognitive neurosciences, and interventional approaches. It aims to help the reader to appropriately design and conduct studies involving these brain stimulation techniques, understand limitations and avoid shortcomings, which might hamper the scientific rigor and potential applications in the clinical domain.
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            Direct current stimulation promotes BDNF-dependent synaptic plasticity: potential implications for motor learning.

            Despite its increasing use in experimental and clinical settings, the cellular and molecular mechanisms underlying transcranial direct current stimulation (tDCS) remain unknown. Anodal tDCS applied to the human motor cortex (M1) improves motor skill learning. Here, we demonstrate in mouse M1 slices that DCS induces a long-lasting synaptic potentiation (DCS-LTP), which is polarity specific, NMDA receptor dependent, and requires coupling of DCS with repetitive low-frequency synaptic activation (LFS). Combined DCS and LFS enhance BDNF-secretion and TrkB activation, and DCS-LTP is absent in BDNF and TrkB mutant mice, suggesting that BDNF is a key mediator of this phenomenon. Moreover, the BDNF val66met polymorphism known to partially affect activity-dependent BDNF secretion impairs motor skill acquisition in humans and mice. Motor learning is enhanced by anodal tDCS, as long as activity-dependent BDNF secretion is in place. We propose that tDCS may improve motor skill learning through augmentation of synaptic plasticity that requires BDNF secretion and TrkB activation within M1. Copyright 2010 Elsevier Inc. All rights reserved.
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              Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation.

              Brain polarization in the form of transcranial direct current stimulation (tDCS), which influences motor function and learning processes, has been proposed as an adjuvant strategy to enhance training effects in Neurorehabilitation. Proper testing in Neurorehabilitation requires double-blind sham-controlled study designs. Here, we evaluated the effects of tDCS and sham stimulation (SHAM) on healthy subjects and stroke patients' self-report measures of attention, fatigue, duration of elicited sensations and discomfort. tDCS or SHAM was in all cases applied over the motor cortex. Attention, fatigue, and discomfort were self rated by study participants using visual analog scales. Duration of perceived sensations and the ability to distinguish tDCS from Sham sessions were determined. Investigators questioning the patients were blind to the intervention type. tDCS and SHAM elicited comparably minimal discomfort and duration of sensations in the absence of differences in attention or fatigue, and could not be distinguished from SHAM by study participants nor investigators. Successful blinding of subjects and investigators and ease of application simultaneously with training protocols supports the feasibility of using tDCS in double-blind, sham-controlled randomized trials in clinical Neurorehabilitation. tDCS could evolve into a useful tool, in addition to TMS, to modulate cortical activity in Neurorehabilitation.
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                Author and article information

                Contributors
                Journal
                Brain Commun
                Brain Commun
                braincomms
                Brain Communications
                Oxford University Press
                2632-1297
                2020
                09 November 2020
                09 November 2020
                : 2
                : 2
                : fcaa179
                Affiliations
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Otolaryngology, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD, USA
                Department of Cognitive Science, Johns Hopkins University , Baltimore, MD, USA
                Author notes
                Correspondence to: Argye Elizabeth Hillis, MD, Professor of Neurology, Executive Vice Chair, Neurology, Director, Cerebrovascular Division, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 446, Baltimore, MD 21287, USA E-mail: argye@ 123456jhmi.edu
                Author information
                http://orcid.org/0000-0002-0927-3764
                Article
                fcaa179
                10.1093/braincomms/fcaa179
                7677607
                33241212
                25162d19-9468-4ed7-8f47-d15448d3bd8d
                © The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 18 February 2020
                : 9 September 2020
                : 16 September 2020
                Page count
                Pages: 14
                Funding
                Funded by: National Institutes of Health, DOI 10.13039/100000002;
                Award ID: K99/R00 DC015554
                Award ID: P50 DC014664
                Categories
                Original Article
                AcademicSubjects/MED00310
                AcademicSubjects/SCI01870

                cerebellum,aphasia,language therapy,stroke,transcranial direct current stimulation

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