Effect Of Repetitive Transcranial Magnetic Stimulation Combined With Speech Training On The Language Rehabilitation Of Post-cerebral Infarction Aphasia

Objective:1.To explore the effect of repetitive transcranial magnetic stimulation(rTMS)combined with speech training on language function of patients with post-cerebral infarction aphasia.2.To explore the effect of rTMS combined with speech training on the severity of aphasia in post-cerebral infarction aphasia patients.3.To explore the effect of rTMS combined with speech training on the relative power of EEG in post-cerebral infarction aphasia patients to clarify the mechanism of language rehabilitation.4.To observe the safety of rTMS combined with speech training therapy.Methods:This study is a randomized controlled trial.From November 2019 to November 2020,45 patients with post-cerebral infarction aphasia who met the inclusion and exclusion criteria were recruited in the Department of Neurology and Rehabilitation Department of Outpatient and Inpatient Department of the Affiliated Hospital of North Sichuan Medical College.The patients were divided into double-hemispheric rTMS group,single-hemispheric rTMS group,and control group by random number table method,15 cases in each group.Intervention method:the three groups of patients received speech training,5 times a week,1 hour each time,10 times in total.The single-hemisphere rTMS group received 1Hz rTMS of the right-hemisphere inferior frontal gyrus,5 times a week,20min each time,a total of 10 times;The double-hemisphere rTMS group received 1Hz rTMS of the right-hemisphere inferior frontal gyrus and 5Hz rTMS of the left-hemisphere inferior frontal gyrus,5 times a week,25min each time,a total of 10 times;The control group received sham rTMS stimulation,5 times a week,20min each time,a total of 10 times.Pre-and post-intervention immediately,the aphasia battery of Chinese(ABC)was performed to assess the patient’s language function,the Boston diagnostic aphasia examination(BDAE)was used to assess the severity of the patient’s aphasia,the quantitative electroencephalogram(QEEG)monitored the changes in the EEG relative power value of the patient’s aphasia,and the rTMS combined with speech training adverse event record table registered the adverse events of the patient during the intervention.Results:1.Baseline data:age,gender,education level,marital status,course of disease,brain infarction volume,National Institutes of Health Stroke Scale(NHISS)scores,and activities of daily living(ADL)scores of the three groups of patients were not statistically different(P>0.05).The language function of the three groups(information,fluency,retelling,naming,listening comprehension),severity of aphasia,and the EEG relative power values of the left-and right-hemispheres frontal areas(α,δ,α,δ,(δ+θ)/(α+β))were no statistical difference(P>0.05).The baseline data were consistent and comparable.2.Improvement of the patient’s language functionIntra-group comparison:after the intervention,the scores of information,fluency,retelling,naming,and listening comprehension on the ABC scale in the three groups were higher than pre-intervention that was the statistically different(P<0.05).Among groups comparison:after the intervention,the retelling and naming scores in double-hemisphere rTMS group and the single-hemisphere rTMS group were significantly higher than the control group,and this was statistically significant(P<0.05).These comparisons were not statistically significant of three groups in information,fluency,listening comprehension scores(P>0.05).There was no statistically significant between the doublehemispheric rTMS group and the single-hemispheric rTMS group in the retelling and naming scores(P>0.05).3.Improvement of the severity of the patients aphasiaIntra-group comparison:the severity of aphasia in the three groups after intervention was higher than pre-intervention,and this was statistically significant(P<0.05).Among groups comparison:after intervention,the severity of aphasia among the three groups was not statistically significant(P>0.05).4.Changes in the relative power value of the patient’s EEGIntra-group comparison:in the double-hemisphere rTMS group,the lefthemisphere frontal area a and δ/δ values in post-intervention were higher than pre-intervention,and the δ and(θ+δ)/(α+β)values were lower than preintervention(P<0.05).The α/δ value in the right-hemisphere frontal area were higher than pre-intervention(P<0.05),and the α,δ,(θ+δ)/(α+β)values were not significantly different pre-and post-intervention(P>0.05).In the singlehemisphere rTMS group,the values of a and α/δ in the left-and righthemisphere frontal area after intervention were higher than pre-intervention,while the values of δ,(θ+δ)/(α+β)were lower than pre-intervention(P<0.05).The a value of left-hemisphere frontal area after intervention in the control group was lower than pre-intervention(P<0.05).Among groups comparison:After intervention,the a value of the lefthemisphere frontal area of the double-hemisphere rTMS group was higher than the control group and lower than the single-hemisphere rTMS group,the δvalue was lower than the control group,and the right-hemisphere frontal area a value was lower than the single-hemisphere rTMS group(P<0.05).After intervention,the a value of the left-hemisphere frontal area in the singlehemisphere rTMS group was higher than the control group,and the δ and(θ+δ)/(α+β)values were lower than the control group(P<0.05)5.The incidence of adverse events in patientsThe incidence of adverse events was 6.67%in the double-hemisphere rTMS group.There were no adverse events in the single-hemisphere rTMS group and the control group.There was no significant difference in the incidence of adverse events among the three groups(P>0.05).Conclusions:1.rTMS combined with speech training could improve the language function of post-cerebral infarction aphasia.The effect of rTMS combined with speech training on retelling and naming of aphasia patients was better than that of speech training alone.2.After rTMS combined with speech training treatment,the severity of aphasia in patients with post-cerebral infarction aphasia was improved,but three groups of intervention methods had no significant difference in the effectiveness of improving the severity of aphasia.3.The EEG relative electrical power values α,δ,α/δ,(δ+θ)/(α+β)could reflect the changes in the cerebral-hemisphere cortical excitability in pre-and post-treatment of rTMS combined with speech training.Compared with the double-hemisphere rTMS group and the control group,the EEG relative electrical power values in single-hemisphere rTMS group changed more obviously,the cortical excitability and language rehabilitation effect were significant,and the application value was greater.4.rTMS combined with speech training was safe in promoting the language rehabilitation of patients with post-cerebral infarction aphasia.