Repetitive Transcranial Magnetic Stimulation and Multi-modality Aphasia Therapy for Post-stroke Non-fluent Aphasia
Repetitive Transcranial Magnetic Stimulation and Multi-modality Aphasia Therapy for Post-stroke Non-fluent Aphasia
Many stroke survivors experience aphasia, a loss or impairment of language affecting the
 production or understanding of speech. One common type of aphasia is known as non-fluent
 aphasia. Patients with non-fluent aphasia have difficulty formulating grammatical sentences,
 often producing short word fragments despite having a good understanding of what others are
 trying to communicate to them. Speech language pathologists (SLPs) play a central role
 rehabilitating persons with aphasia and administer therapy in an attempt to improve
 communication skills. Despite standard therapy, approximately 50% of individuals who
 experience aphasia acutely continue to have language deficits more than 6 months post-stroke.

 In most people, Broca's area is dominant in the left side of the brain. Following a
 left-sided stroke, the right-sided homologue of Broca's area (the pars triangularis), may
 adopt language function. Unfortunately, reorganizing language to the right side of the brain
 seems to be less effective than restoring function to the left hemisphere. Repetitive
 transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, can be
 used to suppress activity of specific regions in the right side of the brain to promote
 recovery of function in the perilesional area. Despite preliminary success in existing
 studies using rTMS in post-stroke aphasia, there is much work to be done to better understand
 the mechanisms underlying recovery. Responses to rTMS have been positive, yet heterogenous,
 which may be related to timing of treatments following stroke.
Inclusion Criteria:

 -  Isolated left middle cerebral artery (MCA) stroke within past 3 months (sub-acute) or
 more than 6 months ago (chronic)

 -  Stroke type: Ischemic or hemorrhagic

 -  Non-fluent aphasia as determined by the Western Aphasia Battery (Fluency < 5)

 -  Right-hand dominant prior to stroke

 -  English is first or primary language

 -  Ability to follow 3-step commands

 Exclusion Criteria:

 -  Prior stroke to the right frontal lobe

 -  Current diagnosis of moderate to severe depression

 -  Diagnosis of any other psychiatric condition

 -  History of other neurologic disorders (e.g., epilepsy, brain tumor)

 -  Contraindication to MRI or TMS (metal in the head or any implanted electrical device)

 -  Has received intensive speech therapy within the past 6 months (>8 hours per week)

 -  Enrolled in another interventional study