An update on the efficacy of noninvasive brain stimulation techniques for the treatment of dysarthria: A systematic review
Faisal Nouman BAIG1,2,3, Min Ney WONG1,2,3, Chung Pui B. KOO1 & Jess LOH1
1. Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
2. Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
3. Research Centre for Language, Cognition, and Neuroscience, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
Introduction
Background: Various noninvasive brain stimulation (NIBS) techniques have been
introduced to promote speech recovery. However, their roles in dysarthria
treatment remain controversial.
Objectives: To gather evidence for the enhancement effects of NIBS in speech
improvements for treating dysarthria following a systematic evaluation of the
original research papers and analysis
Methods: Six search engines were last searched for studies investigating NIBS
and dysarthria as primary inclusion criteria.. Exclusion criteria included non-
dysarthric populations or interventions besides NIBS modalities. The risk of bias
assessment determination was evaluated using an appropriate methodological
quality assessment checklist. Speech-related outcome measures included
perceptual and acoustic analysis of diadochokinetic (DDK), maximum phonation
time and kinematic analysis of DDK. Post-treatment standardised mean
differences between the sham and treatment groups were derived under the
random effects model for measurable variable outcomes.
Results
Forest Plot of Alternating Motion Rate (AMR)
Forest Plot of Alternating Motion Rate (AMR)
Forest Plot of Mean Phonation Time (MPT)
Forest Pot of Sequential Motion Rtae (SMR)
Funding & Acknowledgement
This project was supported by a grant from the Research Grants Council Early
Career Scheme (Grant Number 25609819) (https://www.ugc.edu.hk/eng/rgc/).
The authors would like to thank Yumen Cheung Yuen Man and Chelsia Chan
Cheuk Sze for their active participation in the literature search and
identification of eligible studies.
RESEARCH POSTER PRESENTATION DESIGN © 2022
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Key Findings
❖ Amongst 14 included studies, 9 studies investigated either TMS or iTBS and the
remaining 5 used tDCS.
❖ None of the included studies found were using tFUS or TPS for the treatment of
dysarthria.
❖ TMS applied over Superior Temporal Gyrus (STG): improved tongue and jaw
movement; applied over primary motor cortex enhanced vocal perturbations and
sequential motion rate [5,6]
❖ NIBS has been found used for treatment of dysarthria secondary to cerebral
palsy, cerebrovascular accident, Parkinson’s Disease, cerebellar ataxia, traumatic
brain injury and supranuclear palsy [1-14].
❖ Comparison of TMS over primary motor cortex-mouth area versus left orofacial
left Dorsolateral prefrontal cortex reveled significant improvement in fundamental
frequency [1,17]
❖ Application of high frequency TMS yielded conflicting results in two studies in
terms of improvement in voice quality, intensity and speech rate [6,10]
❖ TMS stimulation over the DLPFC M1 area induced significant effects (p < 0.01) in
harmonic to noise ratio (HNR), net speech rate in sentence repetition task and
sentence reading task compared to stimulation over the SM1[7,10]
❖ Comparing the effects of high frequency stimulation versus low frequency
stimulation of TMS among studies yielded that low frequency (1 Hz to 5Hz)
caused enhanced treatment effects [3,8]
❖ Anodal tDCS stimulation over primary motor cortex in two studies caused
improvement in speech parameters of the post-stroke dysarthric patients [1,2]
❖ Anodal tDCS appeared to be useful adjunct treatment modality for speech therapy
in dysarthria patients [1,2,14]
❖ However, there’s no consensus over treatment regimen (e.g., number of pulses,
current intensity, treatment duration etc)
Conclusions
➢ This review identifies that the current literature is limited to address the research
questions.
➢ Most of the included studies had low power due to the small sample size and low quality
of methodological assessment.
➢ Inter and intra studies heterogeneity impedes the synthesis of pooled effect size.
➢ Large-scale, systemic studies are required to enhance our understanding of the NIBS
actual effect on the recovery of dysarthria
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