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Transcranial direct current stimulation in poststroke aphasia recovery

机译:经颅直流电刺激对中风后失语症的恢复

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摘要

Transcranial direct current stimulation (tDCS), a form of noninvasive brain stimulation originally studied for its effect on motor limb physiology, has been investigated for its use in the treatment of aphasia since 2008. The experimental use of tDCS for aphasia, however, began differently from those paradigms established for poststroke motor recovery, both conceptually and in method. Not only is aphasia research a relative newcomer to the field of tDCS experimentation, it has thus far been somewhat of an outlier in its limited use of tDCS autonomously.Theoretically understood to be vastly more complex than our intricate motor systems, cortical language representation has most recently been conceptualized as a dual stream, diffuse network, with language processing subcomponents evolved from nonlinguistic primates. In the dual stream model, human language functions are lateralized primarily in the left hemisphere, with Broca’s area comprising the left complement of a bilateral dorsal stream network devoted to naming and articulation. Conversely, Wernicke’s area constitutes the origin of a bilateral ventral stream in which semantic meaning is attached to components of speech sounds. Additional activation in homologous right hemisphere language areas seems to be determined by lexical necessity, with increased articulatory demands activated within the bilateral dorsal stream and the decoding of unfamiliar words activated in the bilateral ventral stream network. Complex as it may be to optimally prime the motor cortex for poststroke limb rehabilitation using tDCS, it may be considered even more challenging to modulate the cortical plexus which encodes and produces language in all of its richness. The theoretical mechanisms of brain activation during tDCS protocols suggest that tDCS primes the brain for enhanced outcomes in behavioral therapies, which may have led to the appeal of combining methods concurrently.
机译:经颅直流电刺激(tDCS)是最初研究其对运动肢体生理学影响的一种非侵入性脑刺激形式,自2008年以来就已对其用于治疗失语症进行了研究。然而,实验性使用tDCS进行失语症的方法有所不同。从概念上和方法上为卒中后运动恢复建立的范式。失语症研究不仅是tDCS实验领域的一个相对较新的事物,到目前为止,由于其对tDCS的有限使用,它在某种程度上已经与众不同。从理论上讲,它比我们错综复杂的运动系统要复杂得多,皮层语言表示最最近,它被概念化为双流,分散的网络,具有从非语言灵长类动物进化而来的语言处理子组件。在双流模型中,人类语言功能主要集中在左半球,而Broca的区域包括专门用于命名和发音的双边背流网络的左补。相反,韦尼克(Wernicke)的区域构成了双边腹侧流的起源,在腹侧流中语义与语音成分相关。同源右半球语言区域中的其他激活似乎是由词汇的必要性决定的,在双边背侧流中激活了更多的发音要求,在双边腹侧流网络中激活了不熟悉的单词的解码。使用tDCS为中风后肢康复最佳地灌注运动皮层可能很复杂,因此调制皮层神经丛来编码和产生各种丰富的语言可能更具挑战性。 tDCS协议期间大脑激活的理论机制表明,tDCS可以使大脑为行为疗法中的增强结果做好准备,这可能导致同时使用多种方法的吸引力。

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