| Objective:To explore the clinical efficacy of different modes of transcranial direct current stimulation(tDCS)of the right hemisphere on patients with non-fluent post-stroke aphasia(PSA)in the subacute stage and discuss the relevant factors affecting the efficacy,to guide the clinical application of tDCS in the treatment of non-fluent PSA patients in the subacute stage.Methods:Consult relevant research on non-invasive brain stimulation(NIBS)combined with other language rehabilitation training for PSA to estimate the main outcome index,take α= 0.05,POWER = 0.8,and use PASS 15 software to estimate the total sample size as 60 cases.According to the inclusion and exclusion criteria,60 patients with subacute nonfluent PSA were selected as the research subjects and signed the informed consent.The random number function and visual binning module of SPSS 25 statistical analysis software were used to realize simple random grouping and were divided into 3 groups: anodal stimulation group(n=20),cathodal stimulation group(n=20)and sham stimulation group(n=20).The opaque black envelopes marked with serial numbers were used to hide the groups.The subjects obtained the serial numbers and corresponding envelopes according to the order of enrollment,and the stimulus implementers opened the envelopes to know the groups.Blind the patients(the treatment experiences provided to the 3 groups of patients are indistinguishable)and the curative effect evaluators,but not the stimulus implementers.The stimulus implementers do not participate in the daily treatment of the patients and do not contact the curative effect evaluators.The data will be published after the data collection is completed.After the data collection,the grouping will be released,and the blinding of the patient will be broken when the patient has a condition change that may be related to the stimulation.All the subjects in the 3 groups received online tDCS therapy based on conventional speech and speech therapy(SLT).The anodic stimulation group received tDCS anodic stimulation at the stimulation site,the cathodic stimulation group received tDCS cathodic stimulation at the stimulation site,and the sham stimulation group received tDCS sham stimulation at the stimulation site.The Broca homologous region of the right hemisphere of the subject was selected as the stimulation site,the F8 site of the 10-20 international standard EEG system was used for scalp localization,and the reference electrode was placed at the position of the deltoid muscle of the left shoulder.The current intensity of tDCS was set to 1.5 mA,the duration of stimulation was set to 20 minutes,once a day,5 days a week for 3 weeks.The spontaneous language,auditory comprehension,repetition,naming,and aphasia quotient(AQ)of the Chinese version of the Western Aphasia Battery(WAB)scale were used as evaluation indicators.The evaluation was conducted before the beginning of treatment and 24 hours after the end of treatment.The average value was taken as the final score by two full-time evaluators.In the statistical analysis,α=0.05 was used,and the Graphpad Prism 8.4.2 statistical analysis software was used to conduct statistics and analysis on the data.Results:During the experiment,one subject drops out in the anodic stimulation group,one in the sham stimulation group,and none in the cathodal stimulation group.A total of 58 subjects were included in the statistical analysis,including anodic stimulation group(n =19),cathodal stimulation group(n = 20)and sham stimulation group(n = 19).The age,gender,years of education,course of disease,and type of stroke among the 3 groups of subjects were statistically analyzed,and there was no statistically significant difference between the groups(P > 0.05),which was comparable.The 5 baseline scores(spontaneous language,auditory comprehension,repetition,naming,and AQ score of the WAB scale)of the 3 groups of subjects before the start of treatment were statistically analyzed,and there was no statistically significant difference between the groups(P > 0.05),which was comparable.Intra-group comparison before and after treatment: After 3 weeks of treatment,the 5 scores of subjects in the 3 groups(spontaneous language,auditory comprehension,repetition,naming,and AQ of the WAB scale)were all improved compared with those before treatment,and the difference was statistically significant(P < 0.05).Inter-group comparison of score improvement(improvement is defined as the difference between the score after treatment and the score before treatment): In terms of improvement in spontaneous language,auditory comprehension,naming,and AQ,the anodic stimulation group was superior to the cathodal stimulation group and the sham stimulation group,the difference was statistically significant(P < 0.05),and there was no significant difference between cathodal stimulation group and sham stimulation group(P > 0.05);In terms of improvement in repetition,there was no statistically significant difference among the 3groups(P > 0.05).Conclusions:Based on conventional SLT treatment,anodal tDCS stimulation acting on the Broca homologous area in the right cerebral hemisphere can significantly improve the language function of subacute non-fluent PSA patients.When tDCS is applied to PSA patients,factors such as the patient’s course of disease,lesion size and location,stimulation current intensity,and reference electrode location should be considered comprehensively to achieve a stable effect. |
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