tDCS receptiveness in people with aphasia (Duncan et al., 2022)

Purpose: The objective of this study was to explore receptiveness of people with poststroke aphasia to receiving transcranial direct current stimulation (tDCS), including preferences for the treatment setting and schedule of tDCS delivery. 

Method: An online survey was distributed via e-mail, flyers, social media, and online newsletters to reach people with aphasia. Fisher’s exact test examined the relationship of self-reported tDCS receptiveness to demographic, clinical, and other factors.

Results: Fifty-seven surveys were returned, and 50 complete surveys were analyzed. Twenty-eight percent of respondents had previously heard of tDCS. Sixty-six percent reported they would receive tDCS if it could help their aphasia, and only 6% reported that they definitely would not. There were statistically significant relationships between being receptive to tDCS and (a) not currently working, (b) being receptive to speech-language therapy, and (c) greater acceptance of potential temporary risks associated with tDCS. Most individuals (73%) who would consider tDCS were equivalently open to receiving it in the clinic or at home, yet the majority (64%) were open to more frequent sessions at home than in the clinic. Most respondents indicated that they would consider having tDCS “forever if it helped” (clinic: 51%; home: 68%).

Conclusions: This is the first study to query individuals with aphasia about their receptiveness to tDCS outside the context of an intervention study. Responses suggest that a large majority of people with poststroke aphasia might be open to receiving tDCS if it can ameliorate their aphasia. Limitations include the small sample size, which does not adequately represent the broader population of people with aphasia, and that the survey did not provide the level of tDCS education crucial to inform shared decision making and person-centered care. However, future work may benefit from considering the practical implications of research designs (e.g., high intensity treatment outside the home) that may not, in application, be widely acceptable to primary stakeholders.

Supplemental Material S1. Copy of survey.

SUPPLEMENTAL FIGURE ORGANIZATION (S2–S31)

Summary Demographic Data

Supplemental Materials S2–S8 are histograms characterizing the demographic characteristics of the sample (sex, age, race/ethnicity, education, employment, income, and geographic location).  Plot descriptions and titles indicate the demographic variable. Response options are plotted on the x-axis, and count data (number of respondents for each option) are shown on the y-axis. 

Summary Clinical Data

Supplemental Materials S9–S14 are histograms characterizing the clinical characteristics of the sample (prior strokes, aphasia duration, history of speech therapy, current therapy status, desire to participate in speech therapy [if not currently], and potential tDCS contraindications). Plot descriptions and titles indicate the clinical variable. Response options are plotted on the x-axis, and count data (number of respondents for each option) are shown on the y-axis. 

Receptiveness to tDCS

Supplemental Materials S15–S31 are stacked bar plots relative to the question of whether individuals would consider having tDCS if it could help their aphasia (Question 14 on the survey, also included as a supplement). Groupings shown are those that were used in statistical comparisons (Fisher’s exact test); groups were combined to protect confidentiality (in the case of small group sizes) and items with more than five optional survey responses were reduced to between two and five levels for analysis (combining existing categories into the most equivalent sizes possible). Each plot shows the groupwise percent of individuals responding “Yes,” “Maybe,” or “No” to this question. Sample sizes are included above the bar for each group, and p-values from Fisher’s exact test are included in the plot title (followed by * if p < .05 and ~ if p < .10). Odds ratios are not included as all contingency tables were larger than 2x2.

Demographic Data

Supplemental Materials S15–S20 include groupings used for statistical comparisons (Fisher’s exact test) for each of the demographic variables in Supplemental Materials S2–S8, with the exception of employment status (the figure associated with this statistically significant result is included in the main text).

Clinical Data

Supplemental Materials S21–S25 include groupings used for statistical comparisons with Fisher’s exact test for each of the clinical variables in Supplemental Materials S9–S14, with the exception of desire to participate in therapy (the figure associated with this statistically significant result is included in the main text).

Communicative Participation Item Bank (CPIB) 

Supplemental Material S26 shows the relationship between scores on the CPIB and tDCS receptiveness. 

Receptiveness to Therapy

Supplemental Materials S27–S29 show various combinations of the relationship between receptiveness to therapy in general, receptiveness to therapy concurrent with tDCS, and receptiveness to tDCS.

Acceptability of Risks

Supplemental Materials S30–S31 show significant associations between the number of risks that individuals were willing to accept, either definitely (i.e., “Yes” response) or potentially (i.e., “Maybe” response), and their receptiveness to tDCS.

Duncan, E. S., Donovan, N. J., & Gentimis, T. (2022). Are people with poststroke aphasia receptive to transcranial direct current stimulation? A survey. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2022_AJSLP-21-00190