Einfluss transkranieller Gleichstromstimulation auf gesunde und aphasische Sprachprozessierung

Einleitung: Neuromodulatorische Verfahren werden zunehmend hinsichtlich ihres Potentials, kortikale Leistungsfähigkeit zu beeinflussen, evaluiert. Transkranielle Gleichstromstimulation (tDCS) hat in ersten Studien positive Effekte auf motorische und höhere kognitive Funktionen zeigen können. Für die Beeinflussung der Sprachdomäne bei gesunden und aphasischen Probanden liegen noch keine belastbaren Ergebnisse aus RCTs vor. Deshalb soll bei gesunden Probanden der Einfluss auf ein mehrtägiges Lernen neuer lexikalischer Inhalte evaluiert werden. In der aphasischen Rehabilitation sollen das Fazilitierungspotential von Sprachlernprozessen sowie zugrundeliegende neuronale Wirkmechanismen evaluiert werden. Methodik: Studie 1 soll als Machbarkeitsstudie prüfen, ob Sprachlernprozesse durch CPJ-atDCS bei gesunden, jungen Probanden in ihrer Wirksamkeit gesteigert werden können. In einem zweiarmigen Design lernen 40 Probanden über fünf Tage neue lexikalische Einträge unter CPJ-atDCS oder SHAM-tDCS, behaviorale Leistungen werden unmittelbar nach dem Training und nach Ablauf einer Woche erhoben. Studie 2 untersucht den Einfluss von M1-atDCS auf ein hochfrequentes Benenntraining bei chronischer Aphasie sowie die Wirkung auf ungelernte Kontrollitems und alltagsrelevante Sprache mit sechsmonatiger Nachuntersuchung. In einem zweiarmigen Design wurden 26 Probanden während acht Tagen in jeweils zwei 90minütigen Therapiesitzungen simultan atDCS oder sham-tDCS appliziert. Studie 3 identifiziert neuronale Korrelate von M1-atDCS unter simultaner funktioneller Bildgebung und vermeidet durch einen provozierten Deckeneffekt konfundierende Korrelate behavioraler Veränderungen: 14 Patienten mit Restaphasie wurden unter funktioneller Bildgebung und simultan stattfindender M1-atDCS zuvor korrekt und rasch benannte Items präsentiert und resultierende kortikale Aktivierungsmuster mit denen einer gesunden Kontrollgruppe verglichen. Ergebnisse: In Studie 1 zeigten sich unter TPJ-atDCS umfassendere und schnellere Lernleistungen, die unmittelbar nach der Intervention und nach Ablauf einer Woche nachweisbar waren. In Studie 2 zeigten sich nach M1-atDCS eine bessere Konsolidierung von Therapie- und Transfereffekten sowie eine Generalisierung auf die Alltagskommunikation. In Studie 3 zeigten sich als neuronales Korrelat von M1-atDCS eine Abnahme der kortikalen Aktivierungsintensität im anterioren cingulären Cortex, linken Inselkortex und rechtem Gyrus lingualis bei gesteigerter funktioneller Konnektivität des verbliebenen sprachlichen Netzwerks sowie eine Annäherung an Aktivierungsmuster der gesunden Kontrollen. Schlussfolgerung: Mit in Quantität und Akzeleration gesteigerter Einspeicherung neuer lexikalischer Einträge bei jungen gesunden Probanden zeigte tDCS das Potential, Sprachlernprozesse in ihrer Wirksamkeit zu steigern. Signifikant bessere Konsolidierungsleistungen unter Verum für trainierte Items, signifikant gesteigerte Transferleistungen und Verbesserungen in alltagsrelevanten Kommunikationsparametern verdeutlichen das Potential dieses neuromodulatorischen Verfahrens in der Rehabiliation aphasischer Beeinträchtigungen. Als zugrundeliegender Wirkmechanismus konnte ein reduzierter kortikaler Prozessierungsaufwand bei gesteigerter funktioneller Konnektivität aufgabenspezifischer Netzwerke identifiziert werden.Introduction: Recently, growing interest emerged in the enhancement of human potential by means of non-invasive brain stimulation. In particular, atDCS has been shown to exert beneficial effects on motor and higher cognitive functions. High quality studies fulfilling methodically first class criteria assessing the impact of multiple stimulation sessions are scarce and have not yet been conducted in the language domain with healthy individuals and patients with aphasia. Methods: Study 1 aimed to investigate, whether language learning could be facilitated by atDCS in healthy young participants. In this two armed study 40 participants learned new lexical entries over five days with simultaneous CPJatDCS. Study 2 aimed to evaluate the potential benefits of M1-atDCS in a high frequent naming therapy in chronic aphasia. In this two armed study 26 patients were treated over eight days. Behavioral Performance and communicative skills were tested immediately after the training and after a six-months-follow-up. Study 3 aimed to identify the neuronal underpinning of M1-atDCS with fMRI. In a crossover-study 14 patients suffering from residual aphasia namend items during an fMRI scan with 6 simultaneous application M1-atDCS, cortical activation was compared with healthy controls. Results: In study 1 TPJ-atDCS facilitated more and faster learning, results were maintained throughout the one-week-follow-up. In study 2 M1-atDCS evoked better consolidation of facilitated naming results and transfer effects as well as generalization on daily communication skills rated by primary care giver. Consolidation remained stable during six months follow-up in the active group, while participants receiving sham-stimulation dropped down to baseline niveau. In study 3 a significant decrease of cortical activation in the anterior cingulate cortex, left insula and right lingual gyrus accompanied with a significant increase in functional connectivity of the remaining language- and task-related network could be identified as neuronal correlate of M1-atDCS. Compared with healthy controls, atDCS resulted in overall “normalization” of brain function in the patients. Discussion: These results elucidate the potential of tDCS in rehabilitation of language impairment in aphasia. Reduced cortical effort in language processing and increased language- and task-related functional connectivity seem to be the neuronal underpinning of these tDCS effects. The present studies provide direct evidence that atDCS facilitates language learning over repeated sessions in healthy individuals and that these gains are maintained over time. Thereby, these results contribute important novel information about the potential of atDCS to enhance language re-learning in clinical populations

Transcranial direct current stimulation over multiple days improves learning and maintenance of a novel vocabulary

Introduction: Recently, growing interest emerged in the enhancement of human potential by means of non-invasive brain stimulation. In particular, anodal transcranial direct current stimulation (atDCS) has been shown to exert beneficial effects on motor and higher cognitive functions. However, the majority of transcranial direct current stimulation (tDCS) studies have assessed effects of single stimulation sessions that are mediated by transient neural modulation. Studies assessing the impact of multiple stimulation sessions on learning that may induce long-lasting behavioural and neural changes are scarce and have not yet been accomplished in the language domain in healthy individuals

Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence

Behavioural interventions are effective treatments for overactive bladder (OAB) and urgency urinary incontinence (UUI). They are in part aimed at improving symptoms with patient education on healthy bladder habits and lifestyle modifications, including the establishment of normal voiding intervals, elimination of bladder irritants from the diet, management of fluid intake, weight control, management of bowel regularity and smoking cessation. Behavioural interventions also include specific training techniques aimed at re-establishing normal voiding intervals and continence. Training techniques include bladder training, which includes a progressive voiding schedule together with relaxation and distraction for urgency suppression, and multicomponent behavioural training, which, in conjunction with pelvic floor muscle (PFM) exercises, includes PFM contraction to control urgency and increase the interval between voids. Guidelines for the conservative treatment of OAB and UUI have been published by several organisations and the physiological basis and evidence for the effectiveness of behavioural interventions, including lifestyle modifications, in the treatment of OAB and UUI have been described. However, many primary care clinicians may have a limited awareness of the evidence supporting the often straight-forward treatment recommendations and guidance for incorporating behavioural interventions into busy primary care practices, because most of this information has appeared in the specialty literature. The purpose of this review is to provide an overview of behavioural interventions for OAB and UUI that can be incorporated with minimal time and effort into the treatment armamentarium of all clinicians that care for patients with bladder problems. Practical supporting materials that will facilitate the use of these interventions in the clinic are included; these can be used to help patients understand lifestyle choices and voiding behaviours that may improve function in patients experiencing OAB symptoms and/or UUI as well as promote healthy bladder behaviours and perhaps even prevent future bladder problems. Interventions for stress urinary incontinence are beyond the scope of this review

Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia

See Fink et al. (doi:10.1093/aww034) for a scientific commentary on this article. Transcranial direct current stimulation has shown promise to improve recovery in patients with post-stroke aphasia, but previous studies have only assessed stimulation effects on impairment parameters, and evidence for long-term maintenance of transcranial direct current stimulation effects from randomized, controlled trials is lacking. Moreover, due to the variability of lesions and functional language network reorganization after stroke, recent studies have used advanced functional imaging or current modelling to determine optimal stimulation sites in individual patients. However, such approaches are expensive, time consuming and may not be feasible outside of specialized research centres, which complicates incorporation of transcranial direct current stimulation in day-to-day clinical practice. Stimulation of an ancillary system that is functionally connected to the residual language network, namely the primary motor system, would be more easily applicable, but effectiveness of such an approach has not been explored systematically. We conducted a randomized, parallel group, sham-controlled, double-blind clinical trial and 26 patients with chronic aphasia received a highly intensive naming therapy over 2 weeks (8 days, 2 × 1.5 h/day). Concurrently, anodal-transcranial direct current stimulation was administered to the left primary motor cortex twice daily at the beginning of each training session. Naming ability for trained items (n = 60 pictures that could not be named during repeated baseline assessments), transfer to untrained items (n = 284 pictures) and generalization to everyday communication were assessed immediately post-intervention and 6 months later. Naming ability for trained items was significantly improved immediately after the end of the intervention in both the anodal (Cohen's d = 3.67) and sham-transcranial direct current stimulation groups (d = 2.10), with a trend for larger gains in the anodal-transcranial direct current stimulation group (d = 0.71). Treatment effects for trained items were significantly better maintained in the anodal-transcranial direct current stimulation group 6 months later (d = 1.19). Transfer to untrained items was significantly larger in the anodal-transcranial direct current stimulation group after the training (d = 1.49) and during the 6 month follow-up assessment (d = 3.12). Transfer effects were only maintained in the anodal-transcranial direct current stimulation group. Functional communication was significantly more improved in the anodal-transcranial direct current stimulation group at both time points compared to patients treated with sham-transcranial direct current stimulation (d = 0.75-0.99). Our results provide the first evidence from a randomized, controlled trial that transcranial direct current stimulation can improve both function and activity-related outcomes in chronic aphasia, with medium to large effect sizes, and that these effects are maintained over extended periods of time. These effects were achieved with an easy-to-implement and thus clinically feasible motor-cortex montage that may represent a promising 'backdoor' approach to improve language recovery after stroke

Western Star, 1912-05-08

The Western Star began publication on Newfoundland's west coast on 4 April 1900, appearing weekly with brief semiweekly periods up to 1952, when it became a daily. As of 17 April 2019 it continues as a free weekly community paper

Sloshing and pressurization tests for membrane tank: Tests, validation and models

This paper presents recent 1:1 scaled tests results for sloshing, pressurization and evacuation behaviour in membrane tanks used for spacecrafts and satellites. The first 1:1 scale sloshing test setup evaluates fluid reaction forces for axial, lateral and spin excitations at different fill level. Evaluation and determination of sloshing forces during relevant flight phases is important for flight stability and GNC layout. The test evaluates the impact of pressure level, membrane position, acceleration level and excitation direction. Mathematical reaction force models for accelerated and ballistic flight phases are presented. The second 1:1 scale pressurization test setup shows the transient membrane position during Helium pressurization and evacuation at realistic flow rates. During launch in depressurized condition the mechanical impact on the membrane launch may be reduced in the membrane tank such that the membrane is supported by the tank wall and surrounded by vapour and dissolved gas below the membrane. The tests provide important information of the membrane state for drying, filling procedures and on-flight pressurizations effects. The membrane position during depressurization is dependent on fill level, vapour generation, dissolved gas amount in the test fluid and pressurization rate. The paper evaluates this evaporation and condensation effect below the membrane during the depressurization and repressurization process. Video recordings show the membrane position and gas state inside the membrane tank. In addition complementary test in a vacuum chamber are presented to support the analysis and allow optical observation from the outside

Limited Add-On Effects of Unilateral and Bilateral Transcranial Direct Current Stimulation on Visuo-Motor Grip Force Tracking Task Training Outcome in Chronic Stroke. A Randomized Controlled Trial

Background: This randomized controlled trial investigated if uni- and bihemispheric transcranial direct current stimulation (tDCS) of the motor cortex can enhance the effects of visuo-motor grip force tracking task training and transfer to clinical assessments of upper extremity motor function. Methods: In a randomized, double-blind, sham-controlled trial, 40 chronic stroke patients underwent 5 days of visuo-motor grip force tracking task training of the paretic hand with either unilateral or bilateral (N = 15/group) or placebo tDCS (N = 10). Immediate and long-term (3 months) effects on training outcome and motor recovery (Upper Extremity Fugl-Meyer, UE-FM, Wolf Motor Function Test, and WMFT) were investigated. Results: Trained task performance significantly improved independently of tDCS in a curvilinear fashion. In the anodal stimulation group UE-FM scores were higher than in the sham group at day 5 (adjusted mean difference: 2.6, 95%CI: 0.6–4.5, p = 0.010) and at 3 months follow up (adjusted mean difference: 2.8, 95%CI: 0.8–4.7, p = 0.006). Neither training alone, nor the combination of training and tDCS improved WMFT performance. Conclusions: Visuo-motor grip force tracking task training can facilitate recovery of upper extremity function. Only minimal add-on effects of anodal but not dual tDCS were observed. Clinical Trial Registration: https://clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT01969097&cntry=&state=&city=&dist=, identifier: NCT01969097, retrospectively registered on 25/10/2013