Personalized Language Training and Bi-Hemispheric tDCS Improve Language Network Connectivity in Chronic Aphasia: A fMRI Case Study

Background: Transcranial Direct Current Stimulation (tDCS) has surfaced as a promising neuromodulatory instrument for language rehabilitation in chronic aphasia. Nonetheless, the effects of bi-hemispheric, multisite stimulation are insufficiently investigated, especially in persons with chronic and treatment-resistant language impairments. The goal of this study is to look at the effects on behavior and brain activity of a special language training program that combines bi-hemispheric multisite anodal tDCS with personalized language training for Albert, a patient with long-lasting and stubborn non-fluent aphasia. Methods: Albert, a right-handed retired physician, had transcortical motor aphasia subsequent to a left-hemispheric ischemic stroke occurring more than six years before the operation. Even after years of traditional treatment, his expressive and receptive language problems stayed quite bad and didn't get better. He had 15 sessions of bi-hemispheric multisite anodal tDCS aimed at bilateral dorsal language streams, administered simultaneously with language training customized to address his particular phonological and syntactic deficiencies. Psycholinguistic evaluations were performed at baseline, immediately following the intervention, and at 1, 2, 3, and 6 months post-intervention. Resting-state fMRI was conducted at baseline and following the intervention to evaluate alterations in functional connectivity (FC). Results: We noted statistically significant enhancements in auditory sentence comprehension and oral reading, particularly at the 1- and 3-month follow-ups. Neuroimaging showed that FC was lower in left dorsal language areas and in maladaptive right-hemispheric regions. This finding suggests that language networks are reorganizing in a helpful way. There was no significant improvement in phonological processing, which may indicate reduced connectivity in the left inferior frontal areas. Conclusions: This instance underscores the therapeutic potential of integrating individualized language instruction with bi-hemispheric, network-targeted tDCS to enhance language recovery in individuals with chronic, treatment-resistant aphasia. The convergence of behavioral improvements and brain plasticity in Albert highlights the significance of personalized, network-informed neuromodulation strategies. Additional controlled research is necessary to confirm and enhance this intervention.