الفهرس 
Speech production and speech impairmentOnly 14 pages are availabe for public view
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Abstract
Aphasia, defined as an impaired ability to
communicate, is one of the most feared symptoms of
stroke, being a devastating neurological condition affecting
a person’s ability and thus, reintegrate into the society
(Berthier, 2005).
Despite availability of pharmacological treatments and
professionally administered speech language therapy
(SLT), new strategies are required to boost recovery, either
in the chronic stage of stroke as well as in acute or sub
acute stages augmenting the natural spontaneous
neuroplasticity (Brady & Enderby, 2010).
from such new strategies to mange post stroke aphasia
inducing neuroplasticity and functional recovery in
language areas in the brain are the non invasive brain
stimulation (NBS) devices including transcranial magnetic
stimulation (TMS) (Priyanka et al., 2013).
In the current pilot randomized clinical trail 60 patients
diagnosed as first ever post cerebrovascular ischemic stroke
sufferers of aphasic who were admitted in Ain Shams university or Ain Shams university specialized hospitals
were divided into 3 equal groups.
Each was subjected to careful history taking,
neurological examination, MRI brain imaging, routine
laboratory investigations for risk factors of stroke, Echo
cardiography and carotid duplex.
Besides properly identifying type of aphasia based on
bedside language examination using the western aphasia
battery (WAB).
After identifying aphasia subclass the 60 patients were
divided into 3 equal groups as regards number as well as
aphasia subclass.
The three groups were considered the three arms of the
study; repetitive transcranial magnetic stimulation was
applied to each patient as follows:
Patients in group A were administered stimulatory
rTMS (5 Hz – 90% of motor threshold) over the dominant
language areas based on 10-20 international EEG system
for four successive days followed by another 4 successive
days. Patients in group B were administered inhibitory rTMS
(1 Hz – 90% of motor threshold) over the non dominant
language homologue areas based on 10-20 international
EEG system for four successive days followed by another 4
successive days.
Patients in group C were considered the control/sham
arm of the study and were administered sham rTMS for the
same time interval as the two active groups.
Patients were assessed by the stroke aphasia quality of
life 39 scale as well as stroke aphasia depression
questionnaire at baseline, after ending first 4 sessions of
rTMS (first week), after ending second 4 sessions of rTMS
(second week) and after another 2 weeks (1 month from
enrollment in the study).
The communication domain of SAQOL-39 scale was
separated and statistically analyzed as a separate entity as
well as the above mentioned assessment modalities.
Results were in favor that rTMS effect began to be
pronounced after 8 sessions whether in the stimulated or
inhibited group, yet total groups results whatever the
aphasia subclasses were in favor of the stimulated group On further analysis and on calculating percent of
change as well as rate of change whenever needed of the
aphasia subclasses in different groups, active rTMS was
superior to sham rTMS with inhibitory technique being
more effective than stimulatory technique in global,
receptive and transcortical, while stimulatory technique
being more effective in anomic subclass and neither was
superior in expressive subclass.
Conclusion from the current study that targeting
aphasic patients post stroke in their sub acute stage is
effective and may be more superior than waiting till the
chronic phase of the disability as if bombarding the brain
while spontaneous neuroplasticity is going on by an
external safe modality that will augment neuroplasticity
and rehabilitation.