Transcranial direct current stimulation (tDCS) in patients with aphasia after cerebral stroke
More details
Hide details
Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Polska
Daria Kukuła   

Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Polska
Med Og Nauk Zdr. 2020;26(2):118–123
Cerebral stroke and its consequences are important medical, social and economic problems. Each change in the brain area entails serious consequences related with the functioning of an individual in many domains important for life. For a long time, attention was paid only to the physical problems faced by patients after stroke, and it was the area of concern in rehabilitation. At present, it is known that each stroke event brings about consequences for a patient also in the cognitive and emotional sphere. Transcranial direct current stimulation (tDCS) is one of the promising although still experimental methods in post-stroke rehabilitation. Research to-date indicates the effectiveness of this method in aphasia and cognitive functions rehabilitation. However, this problem area still requires further studies.

The aim of the presented article is to review current research on the effectiveness of tDCS in the cognitive functioning of patients with post-stroke aphasia.

Brief description of the state of knowledge:
Transcranial direct current stimulation is an experimental method in cognitive neurorehabilitation of dysfunction with brain damage. A beneficial effect of tDCS stimulation on improving the functioning of patients with aphasia after stroke has been demonstrated, even with one-off treatment. Scientific reports in this area focus mainly on language functions. There are definitely fewer studies concerning the improvement of other cognitive functions, such as attention, memory or learning ability in aphasic patients.

Currently, tDCS can be seen to have great potential, in particular in the fields of psychology, neurology and geriatrics. Taking into account statistical data and demographic projections, the number of strokes is constantly increasing. The tDCS method can be used, among others, as a non-pharmacological treatment aid in strokes. At the same time, despite promising reports in the field of neurorehabilitation using tDCS, this method still raises many doubts and has the status of experimental activities.

Fregni F, Pascual-Leone A. Technology Insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS. Nat Rev Neurol. 2007; 3(7): 383–93. https://doi. org/10.1038/ncpneuro0530.
Narodowy Fundusz Zdrowia, Statystyka JGP app-jgp/AnalizaPrzekrojowa.aspx (dostęp: 2019.02.10).
Raciborski F, Gujski M, red. Udary mózgu: rosnący problem w starzejącym się społeczeństwie. Raport Instytutu Ochrony Zdrowia. Warszawa: Instytut Ochrony Zdrowia; 2016.
Kaźmierczak M, Wichurska K. Dynamika obrazu zaburzeń mowy u pacjentki po udarze niedokrwiennym mózgu – opis przypadku. Otorynolaryngologia 2018; 17(2): 72–79.
Miguła B. Afazja jako zaburzenie mowy po udarze mózgu: studium przypadku. Logopedia Silesiana 2015; 4: 395–405.
Saunders NLJ, Summers MJ. Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment. Neuropsychology 2011; 25(2): 237–248.
Jodzio K, Biechowska D, Szurowska E. Neuropsychologiczna ocena zaburzeń kontroli wybranych funkcji poznawczych i motorycznych po udarze mózgu. Post Psychiatr Neurol. 2011; 20(4): 251–257.
Kot-Bryćko K, Pietraszkiewicz F. Psychologia w medycynie. Część 2 – rehabilitacja neuropsychologiczna po udarze mózgu. Med Og Nauk Zdr. 2012; 18(4): 344–347.
Herzyk A, Wydawnictwo Naukowe Scholar. Wprowadzenie do neuropsychologii klinicznej. Warszawa: Scholar; 2015.
Fregni F, Pascual-Leone A. Technology Insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS. Nat Rev Neurol. 2007; 3(7): 383–393. https://doi. org/10.1038/ncpneuro0530.
Polanowska K, Seniów J. Wpływ przezczaszkowej stymulacji prądem stałym na funkcjonowanie poznawcze chorych po uszkodzeniu mózgu. Neurol Neurochir Pol. 2010; 44(6): 580–590. S0028-3843(14)60156-0.
Danovska M, Peychinska D. Post-stroke cognitive impairment – phenomenology and prognostic factors. JofIMAB. 2012; 18, 3: 290–297.
Poulin V, Korner-Bitensky N, Dawson DR. Stroke-specific executive function assessment: A literature review of performance-based tools. Aust Occup Ther J. 2013; 60(1): 3–19. 1630.12024.
Sabiniewicz M, Niwald M, Machnia M, Włodarczyk L, Miller E. Selected cognitive dysfunctions after brain stroke – clinical characteristics and diagnosis. Aktual Neurol. 2015; 15(1): 35–40. AN.2015.0006.
Barbay M, Diouf M, Roussel M, Godefroy O. Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies. Dement Geriatr Cogn Disord. 2018; 46(5–6): 322–34.
van Dijk EJ, de Leeuw FE. Recovery after stroke: more than just walking and talking again If you don’t look for it, you won’t find it: Editorials. Eur J Neurol. 2012; 19(2): 189–90. 1331.2011.03520.x.
Jankowska A, Klimkiewicz R, Kubsik A, Klimkiewicz P, Woldańska- Okońska M, Śmigielski J. Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions. Adv Clin Exp Med. 2017; 26(5): 767–76. https://doi.or /10.17219/acem/63138.
Mark VW. Stroke and Behavior. Neurologic Clinics. 2016; 34(1): 205–34.
Maruszewski M. Afazja: zagadnienia teorii i terapii. PWN, 1966.
Maruszewski M. Mowa a mózg: zagadnienia neuropsychologiczne. PWN, 1970.
Ryglewicz D, Milewska D. Epidemiologia afazji u chorych z udarem mózgu. Udar mózgu: problemy interdyscyplinarne. 2004; 6(2): 65–70.
Pąchalska M. Neuropsychologiczna diagnostyka afazji. W: Gałkowski T, Szeląg E, Jastrzębowska G. Podstawy neurologopedii: podręcznik akademicki. Opole: Wydawnictwo Uniwersytetu Opolskiego; 2005, p. 750–845.
Fonseca J, Ferreira JJ, Pavão Martins I. Cognitive performance in aphasia due to stroke: a systematic review. IJDHD. 2017; 16(2). https://
Rijntjes M. Mechanisms of recovery in stroke patients with hemiparesis or aphasia: new insights, old questions and the meaning of therapies: Curr Opin Neurol. 2006; 19(1): 76–83. DOI: 10.1097/01. wco.0000203886.28068.38.
Budzisz J, Szczepanowski R, Kruk P. Przezczaszkowa stymulacja stałoprądowa tDCS w badaniach naukowych mózgu człowieka. PE. 2017; 1(4): 44–47.
Pąchalska M, Kaczmarek BLJ, Kropotov ÛD, Brown JW, Wydawnictwo Naukowe PWN. Neuropsychologia kliniczna: od teorii do praktyki. Warszawa: PWN; 2019.
Woods AJ, Martin D M. Clinical Research and Methodological Aspects for tDCS Research. In: Brunoni A, Nitsche M, Loo C, red.Transcranial Direct Current Stimulation in Neuropsychiatric Disorders Cham: Springer International Publishing; 2016, p. 393–404. https://doi. org/10.1007/978-3-319-33967-2.
Lang N, Siebner HR, Ward NS, Lee L, Nitsche MA, Paulus W, i in. How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain?: tDCS-induced changes of rCBF. Eur J Neurosci. 2005; 22(2): 495–504. https://doi. org/10.1111/j.1460-9568.2005.04233.x.
Stagg CJ, Nitsche MA. Physiological Basis of Transcranial Direct Current Stimulation. NRO. 2011; 17(1): 37–53. https://doi. org/10.1177/1073858410386614.
Hauser TU, Rotzer S, Grabner RH, Mérillat S, Jäncke L. Enhancing performance in numerical magnitude processing and mental arithmetic using transcranial Direct Current Stimulation (tDCS). Front Hum Neurosci. 2013; 7.
Hoy KE, Emonson MRL, Arnold SL, Thomson RH, Daskalakis ZJ, Fitzgerald PB. Testing the limits: Investigating the effect of tDCS dose on working memory enhancement in healthy controls. Neuropsychologia. 2013; 51(9): 1777–1784. neuropsychologia.2013.05.018.
Javadi AH, Cheng P. Transcranial Direct Current Stimulation (tDCS) Enhances Reconsolidation of Long-Term Memory. Brain Stimul. 2013; 6(4): 668–674.
Minati L, Campanhã C, Critchley HD, Boggio PS. Effects of transcranial direct-current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) during a mixed-gambling risky decision-making task. Cogn Neurosci. 2012; 3(2): 80–88. 628382.
Ruf SP, Fallgatter AJ, Plewnia C. Augmentation of working memory training by transcranial direct current stimulation (tDCS). Sci Rep. 2017; 7(1): 876.
Kuo M-F, Mosayebi M, Jamil A, Nitsche MA. S181. Optimizing the neuroplastic effects of cathodal transcranial direct current stimulation (tDCS) over the primary motor cortex. Clin Neurophysiol. 2018; 129: e209.
Samani MM, Agboada D, Jamil A, Kuo M, Nitsche M. Cathodal Transcranial Direct Current Stimulation over the Primary Motor Cortex Induces Nonlinear Neuroplasticity with Modulations of Intensity and Duration. Brain Stimul. 2019; 12(2): 405. brs.2018.12.309.
Venkatakrishnan A, Sandrini M. Combining transcranial direct current stimulation and neuroimaging: novel insights in understanding neuroplasticity. J Neurophysiol. 2012; 107(1): 1–4. https://doi. org/10.1152/jn.00557.2011.
Saur D. Dynamics of language reorganization after stroke. Brain. 2006; 129(6): 1371–1384.
Webster BR, Celnik PA, Cohen LG. Noninvasive brain stimulation in stroke rehabilitation. NeuroRX. 2006; 3(4): 474–481. https://doi. org/10.1016/j.nurx.2006.07.008.
Brunoni A, Nitsche M, Loo C (red.). Transcranial Direct Current Stimulation in Neuropsychiatric Disorders. Cham: Springer International Publishing; 2016.
Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, i in. Transcranial direct current stimulation: State of the art 2008. Brain Stimul. 2008; 1(3): 206–223.
Hesse S, Werner C, Schonhardt EM, Bardeleben A, Jenrich W, Kirker SG. Combined transcranial direct current stimulationand robot-assisted arm training in subacute stroke patients:a pilot study. Restor Neurol Neurosci 2007; 25: 9–15.
Monti A, Cogiamanian F, Marceglia S, Ferrucci R, Mameli F, Mrakic- Sposta S, et al. Improved naming after transcranial direct current stimulation in aphasia. J Neurol Neurosurg Psychiatry. 2008; 79(4): 451–453.
Marangolo P, Marinelli CV, Bonifazi S, Fiori V, Ceravolo MG, Provinciali L, et al. Electrical stimulation over the left inferior frontal gyrus (IFG) determines long-term effects in the recovery of speech apraxia in three chronic aphasics. Behav Brain Res. 2011; 225(2): 498–504. https://doi. org/10.1016/j.bbr.2011.08.008.
Fiori V, Cipollari S, Di Paola M, Razzano C, Caltagirone C, Marangolo P. tDCS stimulation segregates words in the brain: evidence from aphasia. Front Hum Neurosci 2013; 7: 269. fnhum.2013.00269.
Marangolo P, Fiori V, Calpagnano MA, Campana S, Razzano C, Caltagirone C, et al. tDCS over the left inferior frontal cortex improves speech production in aphasia. Front Hum Neurosci. 2013; 7: 539. https://
Wu D, Wang J, Yuan Y. Effects of transcranial direct current stimulation on naming and cortical excitability in stroke patients with aphasia. Neurosci Lett. 2015; 589: 115–120. neulet.2015.01.045.
Jung I-Y, Lim JY, Kang EK, Sohn HM, Paik N-J. The Factors Associated with Good Responses to Speech Therapy Combined with Transcranial Direct Current Stimulation in Post-stroke Aphasic Patients. Ann Rehabil Med. 2011; 35(4): 460.
Kang EK, Kim YK, Sohn HM, Cohen LG, Paik N-J. Improved picture naming in aphasia patients treated with cathodal tDCS to inhibit the right Broca’s homologue area. Restor Neurol Neurosci. 2011; 29(3): 141–52. DOI: 10.3233/RNN-2011-0587.
Rosso C, Perlbarg V, Valabregue R, Arbizu C, Ferrieux S, Alshawan B, et al. Broca’s Area Damage is Necessary but not Sufficient to Induce After-effects of cathodal tDCS on the Unaffected Hemisphere in Post-stroke Aphasia. Brain Stimul. 2014; 7(5): 627–35.
You DS, Kim D-Y, Chun MH, Jung SE, Park SJ. Cathodal transcranial direct current stimulation of the right Wernicke’s area improves comprehension in subacute stroke patients. Brain Lang. 2011; 119(1): 1–5.
D’Agata F, Peila E, Cicerale A, Caglio MM, Caroppo P, Vighetti S, et al. Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation. Front Behav Neurosci. 2016; 10: 135.
Jo JM, Kim Y-H, Ko M-H, Ohn SH, Joen B, Lee KH. Enhancing the Working Memory of Stroke Patients Using tDCS. Am J Phys Med Rehabil. 2009; 88(5): 404–409.
Park SD, Kim JY, Song HS. Effect of application of transcranial direct current stimulation during task-related training on gait ability of patients with stroke. J Phys Ther Sci. 2015; 27(3): 623–625. https://doi. org/10.1589/jpts.27.623.