| Objective: Based on the perspective of cognitive neuropsychology,the impaired language processesare different in different types of Aphasia patients.Their language processing brain areasare not the same.Precise targeted treatment is the guarantee for aphasia patients.We want to focus on the damaged brain regions base on the language processing in aphasia patients and do the treatment precisely by transcranial magnetic stimulation(TMS)and scalp acupuncture.This method can provide direct and reliable guidance for the design and implementation of training programs for aphasia patients.Methods: 48 patients with aphasia after stroke in subacute phase were randomly divided into four groups: correlating brain region TMS group?conventional TMS group?correlating brain region scalp acupuncture group and conventional acupuncture group.Firstly,12 aphasia patients in correlating brain region TMS groupand 12 aphasia patients in the correlating brain region scalp acupuncture group were assessed with Chinese Aphasia Psycholinguistic Assessment(PACA)to determine the damaged language processing pathway.They were divided into two subgroups:the semantic impairment subgroup and the phonological impairment subgroup based on the test scores below 70%.We took the posterior part of the left middle temporal gyrus as therapeutic target in the semantic impairment subgroup and the left inferior frontal gyrus as therapeutic target in the phonological impairment subgroup.All of this subgroup patients in the correlating brain region TMS group accepted high frequency(5Hz)TMStherapy.In the correlating brain region scalp acupuncture group,the semantic impairment subgroup was treated by scalp acupuncture around the surface projection area of posterior part of the left middle temporal gyrus.The phonological impairment subgroup was treated by scalp acupuncture around the surface projection area of left inferior frontal gyrus.All of the subgroup patients accepted about 4~8 needles around the projection area and the direction toward the center of the projection area.Theaphasia patients in conventional TMS group accepted low frequency(1Hz)TMS therapywith Broca's Mirror region of the right hemisphere as the therapeutic target.The conventional acupuncture points were treated in the conventional acupuncture group.The treatment was taken 5 times a week and 2 weeks totally.The Western Aphasia Battery Test(WAB),picture naming test and the severity of aphasia in Boston Diagnostic Aphasia test(BDAE)was measured before and after the treatment.The scores of spontaneous language,comprehension,repetition,naming,aphasia quotient(AQ),the picture naming score and reaction time,severity of aphasia were recorded and analyzed.Results: 1Comparison of language function in the four groups There was no significant difference between the four groups in AQ and spontaneous language,comprehension,repetition and naming before treatment,which showed that the four groups were comparable(P>0.05).There were significant differences in comprehension function and spontaneous language function between the four groups after treatment.Spontaneous language function:X~2=3.112,P=0.037.Comprehension function:X~2=4.632,P=0.021,which suggested that the comprehension function and spontaneous language function in the four groups were different.We need to make pairwise comparisons among the four groups.1.1Comparison of language function before and after TMS therapy Rank sum test of two independent samples:there were significant differences in comprehension function between the two groups after TMS.The score of correlating brain region TMS group was 108.5(68.25,125.25),the conventional TMS group was 70.0(49.75,98.5),Z=-2.19,P=0.028,which suggested that the comprehension function in correlating brain region TMS group improved better.The scores of AQ,comprehension,repetition and naming in the correlating brain region TMS group were significantly improved after TMS,compared with those before treatment(P<0.05).Only AQ and repetition in the conventional TMS group were significantly improved after TMS,compared with those before treatment(P<0.05).It suggested that the language ability could improve better in aphasia patients with correlating brain region TMS treatment,especially in the spontaneous language,comprehension and naming function.1.2 Comparison of language function before and after acupuncture Rank sum test of two independent samples:there were significant differences in spontaneous language function between the two groups after treatment.The score of correlating brain region scalp acupuncture group was 9.0(8.25,10.00),the conventional acupuncture group was 8.0(7.0,9.0),Z=-2.95,P=0.003,which suggested that the spontaneous language function in correlating brain region scalp acupuncture group improved better.The scores of AQ,spontaneouslanguage,comprehension,repetition and naming in the correlating brain region scalp acupuncture group were significantly improved,compared with those before treatment(P<0.05).Excepted spontaneous language,other language functions were improved significantly in the conventional acupuncture group compared with those before treatment(P<0.05).1.3 Comparison of language function between correlating brain region TMS group and correlating brain region scalp acupuncture group.There was no significant difference between the two groups in AQ and spontaneous language,comprehension,repetition and naming after treatment(P>0.05).1.4 Comparison of language function between conventional TMS group and conventional acupuncture group.Rank sum test of two independent samples:There was no significant difference in AQ and spontaneous language,comprehension,repetition and naming after treatment between the two groups(P>0.05).2 Comparison of picture naming Kruskal-Wallis test of multiple independent samples:there was no significant difference between four groups in picture naming score and naming response time beforetreatment(P>0.05),which indicated that they are clinical comparability.Aftertreatment,the picture naming score and the naming response time were significant difference between the four groups,X~2=19.228,P=0.000.It is suggested the effects on naming response time were different between the four groups in aphasia patients.2.1 Comparison of picture naming before and after TMS therapy Rank sum test of two independent samples: after TMS treatment,the naming response time was 9.50(8.53,10.47)of in correlating brain region TMS group and 12.05(11.1,12.737)in conventional TMS group,Z=-3.58,P=0.000,suggesting that the time required for naming was shorter in patients with aphasia accepted correlating brain region TMS treatment.Rank sum test of two related samples:compared to pre-treatment,the scores of picture naming and response time in correlating brain region TMS group were better after TMS treatment(P<0.05).After TMS treatment,the naming response time of conventional TMS group was significantly lower than that before treatment(P<0.05).2.2 Comparison of picture naming before and after acupuncture Rank sum test of two independent samples:there was no significant difference between two groups in picture naming score and naming response time after treatment between these two groups(P>0.05).Compared to pre-treatment,the scores of picture naming and response time in correlating brain region scalp acupuncture group were better(P<0.05),but the conventional acupuncture group only naming response time improved significantly(P<0.05).2.3 Comparison of picture naming between correlating brain region TMS group and correlating brain region scalp acupuncture group.There was no significant difference in picture naming scores between the two groups after treatment(P>0.05).The naming response time of correlating brain region TMS group was 9.50(8.53,10.47),and correlating brain region scalp acupuncture group was 12.35(11.15,13.25),Z=-3.669,P=0.000.These results suggested that correlating brain region TMS groupwas superior to correlating brain region scalp acupuncture group in picture naming response.2.4 comparison of picture naming between conventional TMS group and conventional acupuncture group.Rank sum test of two independent samples:there were no significant difference in picture naming scores naming response time between conventional TMS group and conventional acupuncture group(P>0.05).3Comparison the severity of aphasia Chi-square test compared by multiple sample rates:there was no significant difference between the four groups in the severity of aphasia,X~2=2.291,P=0.933.It is suggested the effects on severity of aphasiain aphasia patients were similar in these four groups.4 Comparison between the phonological impairment subgroup and the semantic impairment subgroup after corresponding brain regions treatment.4.1 Comparison between subgroups in the correlating brain region TMS group:the correlating brain region TMS group was divided into two subgroups:the phonological impairment subgroup and the semantic impairment subgroup.The AQ,comprehension and naming in the phonological impairment subgroup were significantly improved after treatment(P<0.05).In the semantic impairment subgroup,the AQ,comprehension and repetition were significantly improved(P<0.05).4.2 Comparison between subgroups in the correlating brain region scalp acupuncture group:the correlating brain region TMS group was divided into two subgroups:the phonological impairment subgroup and the semantic impairment subgroup.The two subgroups were tested for the rank sum of two related samples before and after treatment.The AQ and the scores of spontaneous language,comprehension and naming in phonological impairment subgroup were significantly improved compared with those before treatment(P<0.05).There was no significant difference in AQ and the scores ofvarious language functions in the semantic impairment subgroup(P>0.05),suggesting that the language function in the phonological impairment subgroup was improved better than that of in the semantic impairment subgroup after scalp acupuncture.Conclusions: 1 The aphasia patients treated by TMS which focus on the impaired language center was significantly improved in the comprehension function and picture naming responsetime.It was superior to the patients treated by TMS based on the mirror image of right Broca.2 The spontaneous language function in aphasia patients treated by scalp acupuncture based on the projection area of the damaged language center was obviously improved,which is better than conventional acupuncture.3 The method of scalp acupuncture based on the projection area of the damaged language center is more effective for phonological impairment patients than semantic impairment patients.TMS targeting therapy is better than scalp acupuncture in aphasia patients with semantic impairment. |
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