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The effects of intermittent theta burst stimulation on progressive non-fluent aphasia: A pilot study
This pilot study will assess the feasibility and potential efficacy of an emerging state of the art treatment approach (Transcranial Magnetic Stimulation) for persons with Progressive Non-Fluent Aphasia (PNFA) in conjunction with both behavioural and brain outcome measures.
The project aligns with the “Communicating Mind and Body” theme and involves a new collaboration between researchers in the School of Audiology and Speech Sciences, the Centre for Brain Health, and the Department of Psychiatry.
PNFA, a clinical subgroup of the primary progressive aphasias, is a neurodegenerative disease manifested by effortful, non-fluent speech, with particular difficulties in grammatical production and comprehension. PNFA causes profound functional disability, with most patients becoming mute several years after diagnosis. Therapies that aim to maintain language function for PNFA patients are, therefore, imperative for preserving communication ability, independence and quality of life. The primary objective of this pilot study is to investigate the linguistic and neurophysiological effects of a course of intermittent theta burst stimulation (iTBS) on dominant inferior frontal lobe stimulation in patients with PNFA. We hypothesize that participants who receive iTBS treatment will show improvement in their language abilities and changes in their underlying functional neurophysiology, as measured by functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). Ten persons diagnosed with PNFA will be recruited for participation. The study will employ a crossover A1BA2 study design, with A1 being baseline phase; B the intervention phase with iTBS; and A2 the post-intervention phase. Each phase will last 4 weeks, for a total of 12 weeks. The participants will undergo language testing during each phase. The behavioural and neurophysiological effects of iTBS will be measured as the magnitude of pre-to-post treatment changes on each outcome measure. Should the findings from this pilot study show promise, further research would be warranted to determine the efficacy of TMS as a safe, non-invasive intervention for patients with PNFA.
PI: Tami Howe, Assistant Professor, Audiology and Speech Sciences. Co-Investigators: Jeff Small, Associate Professor, Audiology and Speech Sciences; Maya Lichtenstein and Rodrigo Santibanez, Behavioral Neurology Fellows, Centre for Brain Health; Fidel Vila-Rodriguez, Assistant Professor, Psychiatry; Howard Feldman, Professor, Neurology.