Randomized trial of iReadMore word reading training and brain stimulation in central alexia

Woodhead et al. present results from a randomized trial of a novel reading therapy app ('iReadMore') coupled with anodal transcranial direct current stimulation (tDCS) in patients with post-stroke central alexia. Use of iReadMore improves reading accuracy for trained words, while concurren...

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Bibliographic Details
Published in:Brain (London, England : 1878) England : 1878), 2018-07, Vol.141 (7), p.2127-2141
Main Authors: Woodhead, Zoe V J, Kerry, Sheila J, Aguilar, Oscar M, Ong, Yean-Hoon, Hogan, John S, Pappa, Katerina, Leff, Alex P, Crinion, Jennifer T
Format: Article
Language:English
Subjects:
Adult
Aged
Aphasia - therapy
Brain
Dyslexia - therapy
Dyslexia, Acquired - therapy
Female
Humans
Language
Male
Middle Aged
Original
Prefrontal Cortex - physiopathology
Reading
Semantics
Stroke - complications
Transcranial Direct Current Stimulation - methods
Verbal Learning
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Summary:Woodhead et al. present results from a randomized trial of a novel reading therapy app ('iReadMore') coupled with anodal transcranial direct current stimulation (tDCS) in patients with post-stroke central alexia. Use of iReadMore improves reading accuracy for trained words, while concurrent tDCS facilitates training and improves generalization to untrained stimuli. Abstract Central alexia is an acquired reading disorder co-occurring with a generalized language deficit (aphasia). We tested the impact of a novel training app, 'iReadMore', and anodal transcranial direct current stimulation of the left inferior frontal gyrus, on word reading ability in central alexia. The trial was registered at www.clinicaltrials.gov (NCT02062619). Twenty-one chronic stroke patients with central alexia participated. A baseline-controlled, repeated-measures, crossover design was used. Participants completed two 4-week blocks of iReadMore training, one with anodal stimulation and one with sham stimulation (order counterbalanced between participants). Each block comprised 34 h of iReadMore training and 11 stimulation sessions. Outcome measures were assessed before, between and after the two blocks. The primary outcome measures were reading ability for trained and untrained words. Secondary outcome measures included semantic word matching, sentence reading, text reading and a self-report measure. iReadMore training resulted in an 8.7% improvement in reading accuracy for trained words (95% confidence interval 6.0 to 11.4; Cohen's d = 1.38) but did not generalize to untrained words. Reaction times also improved. Reading accuracy gains were still significant (but reduced) 3 months after training cessation. Anodal transcranial direct current stimulation (compared to sham), delivered concurrently with iReadMore, resulted in a 2.6% (95% confidence interval −0.1 to 5.3; d = 0.41) facilitation for reading accuracy, both for trained and untrained words. iReadMore also improved performance on the semantic word-matching test. There was a non-significant trend towards improved self-reported reading ability. However, no significant changes were seen at the sentence or text reading level. In summary, iReadMore training in post-stroke central alexia improved reading ability for trained words, with good maintenance of the therapy effect. Anodal stimulation resulted in a small facilitation (d = 0.41) of learning and also generalized to untrained items. 5796149281001 awy138media1 5796149281001
ISSN:0006-8950
1460-2156
DOI:10.1093/brain/awy138