A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times?

BACKGROUND: "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS: We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS: Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION: CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION: The review was recorded on Prospero (01-03-2020), with the registration number 135,627.

Co-existence of depression and post-concussion syndrome one month after mild traumatic brain injury.

BACKGROUND: Previous studies suggest an association between Post-concussion syndrome (PCS) and depression, both highly prevalent after mTBI. OBJECTIVE: To assess the prevalence and risk-factors of depression among patients with PCS 1 month after mTBI. METHODS: We prospectively screened 372 mTBI patients admitted in two academic Emergency Departments between 2017 and 2019. One month after mTBI, we administered the Rivermead Post-concussion symptoms Questionnaire (RPQ) and the Patient Health Questionnaire (PHQ-9) questionnaires over the telephone. PCS and depression were defined by RPQ ≥ 12 and PHQ-9 ≥ 10. Multivariate multinomial regression identified baseline factors associated with PCS and depression. RESULTS: Two hundred and eight completed RPQ and PHQ-9. Forty-seven patients (22.5%) met criteria for PCS, among which 22 (46.8%) met criteria for depression (PCS+D+). Patients with PCS but without depression were less likely to present with an associated injury (Coefficient = -1.6, p = 0.047) and to report initial sadness (Coefficient = -2.5, p = 0.03). Initial sadness (Coefficient = -1.3, p = 0.047), associated injury (Coefficient = -1.9, p = 0.008), as well as initial nausea (Coefficient = -1.8, p = 0.002), and male sex (Coefficient = 1.8, p = 0.002), were associated with the absence of depression and PCS in comparison with PCS+D+ patients. CONCLUSION: Among patients with PCS 1 month after mTBI, those with depression are more likely to present with initial sadness and with an associated injury.

VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey.

Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.

Assisted walking-in-place: Introducing assisted motion to walking-by-cycling in embodied virtual reality.

In this paper, we investigate the use of a motorized bike to support the walk of a self-avatar in virtual reality (VR). While existing walking-in-place (WIP) techniques render compelling walking experiences, they can be judged repetitive and strenuous. Our approach consists in assisting a WIP technique so that the user does not have to actively move in order to reduce effort and fatigue. We chose to assist a technique called walking-by-cycling, which consists in mapping the cycling motion of a bike onto the walking of the user's self-avatar, by using a motorized bike. We expected that our approach could provide participants with a compelling walking experience while reducing the effort required to navigate. We conducted a within-subjects study where we compared "assisted walking-by-cycling" to a traditional active walking-by-cycling implementation, and to a standard condition where the user is static. In the study, we measured embodiment, including ownership and agency, walking sensation, perceived effort and fatigue. Results showed that assisted walking-by-cycling induced more ownership, agency, and walking sensation than the static simulation. Additionally, assisted walking-by-cycling induced levels of ownership and walking sensation similar to that of active walking-by-cycling, but it induced less perceived effort. Taken together, this work promotes the use of assisted walking-by-cycling in situations where users cannot or do not want to exert much effort while walking in embodied VR such as for injured or disabled users, for prolonged uses, medical rehabilitation, or virtual visits.

A Systematic Review of Navigation Assistance Systems for People With Dementia.

Technological developments provide solutions to alleviate the tremendous impact on the health and autonomy due to the impact of dementia on navigation abilities. We systematically reviewed the literature on devices tested to provide assistance to people with dementia during indoor, outdoor and virtual navigation (PROSPERO ID number: 215585). Medline and Scopus databases were searched from inception. Our aim was to summarize the results from the literature to guide future developments. Twenty-three articles were included in our study. Three types of information were extracted from these studies. First, the types of navigation advice the devices provided were assessed through: (i) the sensorial modality of presentation, e.g., visual and tactile stimuli, (ii) the navigation content, e.g., landmarks, and (iii) the timing of presentation, e.g., systematically at intersections. Second, we analyzed the technology that the devices were based on, e.g., smartphone. Third, the experimental methodology used to assess the devices and the navigation outcome was evaluated. We report and discuss the results from the literature based on these three main characteristics. Finally, based on these considerations, recommendations are drawn, challenges are identified and potential solutions are suggested. Augmented reality-based devices, intelligent tutoring systems and social support should particularly further be explored.

Reliability and minimal detectable change of body-weight distribution and body sway between right and left brain-damaged patients at a chronic stage.

PURPOSE: To assess the reliability and minimal detectable change (MDC) of weight-bearing asymmetry (WBA) and body sway (BS) during "eyes open" (EO) and "eyes closed" (EC) conditions for those with right brain damage (RBD) and left brain damage (LBD) at a chronic stage. METHODS: Sixteen RBD and 16 LBD patients participated in two sessions within 15 days, composed of two trials of 30 s using a double force platform. Intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), and MDC were calculated for WBA and BS (area and velocity of sway). RESULTS: Reliability of WBA was excellent (>0.75) except for EC for LBD patients (low SEM was found). The condition of EC was similar to or less reliable than that of EO. The MDC of WBA was 5.4 and 7.3% for LBD and RBD patients, respectively. Velocity of sway should be favored over the area of sway due to better reliability, with an MDC of 9 and 13 mm/s for RBD and LBD patients, respectively. CONCLUSIONS: Parameters related to WBA and BS were highly reliable, without a difference between RBD and LBD patients, but less so in the condition of EC, and could be used for clinical rehabilitation and/or research.Implications for rehabilitationWeight-bearing asymmetry (WBA) and body sway (BS) are highly reliable posturography parameters.Reliability of WBA/BS is similar among right brain damaged (RBD) and left brain damaged (LBD) patients.A change of 5-7% can be interpreted as significant for WBA for chronic stroke.The minimal detectable change in measures is slightly higher for RBD patients.

Influence of User Posture and Virtual Exercise on Impression of Locomotion During VR Observation.

A seated user watching his avatar walking in Virtual Reality (VR) may have an impression of walking. In this paper, we show that such an impression can be extended to other postures and other locomotion exercises. We present two user studies in which participants wore a VR headset and observed a first-person avatar performing virtual exercises. In the first experiment, the avatar walked and the participants (n=36) tested the simulation in 3 different postures (standing, sitting and Fowler's posture). In the second experiment, other participants (n=18) were sitting and observed the avatar walking, jogging or stepping over virtual obstacles. We evaluated the impression of locomotion by measuring the impression of walking (respectively jogging or stepping) and embodiment in both experiments. The results show that participants had the impression of locomotion in either sitting, standing and Fowler's posture. However, Fowler's posture significantly decreased both the level of embodiment and the impression of locomotion. The sitting posture seems to decrease the sense of agency compared to standing posture. Results also show that the majority of the participants experienced an impression of locomotion during the virtual walking, jogging, and stepping exercises. The embodiment was not influenced by the type of virtual exercise. Overall, our results suggest that an impression of locomotion can be elicited in different users' postures and during different virtual locomotion exercises. They provide valuable insight for numerous VR applications in which the user observes a self-avatar moving, such as video games, gait rehabilitation, training, etc.

Effect of Vibrations on Impression of Walking and Embodiment With First- and Third-Person Avatar.

We investigate how underfoot vibrotactile feedback can be used to increase the impression of walking and embodiment of static users represented by a first- or third-person avatar. We designed a multi-sensory setup involving avatar displayed on an HMD, and a set of vibrotactile effects displayed at every footstep. In a first study (N = 44), we compared the impression of walking in 3 vibrotactile conditions : 1) with a "constant" vibrotactile rendering reproducing simple contact information, 2) with a more sophisticated "phase-based" vibrotactile rendering the successive contacts of a walking cycle and 3) without vibrotactile feedback. The results show that overall both constant and phase-based rendering significantly improve the impression of walking in first and third-person perspective. Interestingly, the more realistic phase-based rendering seems to increase significantly the impression of walking in the third-person condition, but not in the first-person condition. In a second study (N=28), we evaluated the embodiment towards first- and third-person avatar while receiving no vibrotactile feedback or by receiving vibrotactile feedback. The results show that vibrotactile feedback improves embodiment in both perspectives of the avatar. Taken together, our results support the use of vibrotactile feedback when users observe first- and third-person avatar. They also suggest that constant and phase-based rendering could be used with first-person avatar and support the use of phase-based rendering with third-person avatar. They provide valuable insight for stimulations in any VR applications in which the impression of walking is prominent such as for virtual visits, walking rehabilitation, video games, etc.

A Systematic Review of Treatments of Post-Concussion Symptoms.

Approximately 10−20% of patients who have sustained a mild Traumatic Brain Injury (mTBI) show persistent post-concussion symptoms (PCS). This review aims to summarize the level of evidence concerning interventions for PCS. Following the PRISMA guidelines, we conducted a systematic review regarding interventions for PCS post-mTBI until August 2021 using the Medline, Cochrane, and Embase databases. Inclusion criteria were the following: (1) intervention focusing on PCS after mTBI, (2) presence of a control group, and (3) adult patients (≥18 y.o). Quality assessment was determined using the Incog recommendation level, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool. We first selected 104 full-text articles. Finally, 55 studies were retained, including 35 that obtained the highest level of evidence. The risk of bias was high in 22 out of 55 studies. Cognitive training, psycho-education, cognitive behavioral therapy, and graded return to physical activity demonstrated some effectiveness on persistent PCS. However, there is limited evidence of the beneficial effect of Methylphenidate. Oculomotor rehabilitation, light therapy, and headache management using repetitive transcranial magnetic stimulation seem effective regarding somatic complaints and sleep disorders. The preventive effect of early (<3 months) interventions remains up for debate. Despite its limitations, the results of the present review should encourage clinicians to propose a tailored treatment to patients according to the type and severity of PCS and could encourage further research with larger groups.

Multi-sensory display of self-avatar's physiological state: virtual breathing and heart beating can increase sensation of effort in VR.

In this paper we explore the multi-sensory display of self-avatars' physiological state in Virtual Reality (VR), as a means to enhance the connection between the users and their avatar. Our approach consists in designing and combining a coherent set of visual, auditory and haptic cues to represent the avatar's cardiac and respiratory activity. These sensory cues are modulated depending on the avatar's simulated physical exertion. We notably introduce a novel haptic technique to represent respiratory activity using a compression belt simulating abdominal movements that occur during a breathing cycle. A series of experiments was conducted to evaluate the influence of our multi-sensory rendering techniques on various aspects of the VR user experience, including the sense of virtual embodiment and the sensation of effort during a walking simulation. A first study ($\mathrm{N}=30$) that focused on displaying cardiac activity showed that combining sensory modalities significantly enhances the sensation of effort. A second study ($\mathrm{N}=20$) that focused on respiratory activity showed that combining sensory modalities significantly enhances the sensation of effort as well as two sub-components of the sense of embodiment. Interestingly, the user's actual breathing tended to synchronize with the simulated breathing, especially with the multi-sensory and haptic displays. A third study ($\mathrm{N}=18$) that focused on the combination of cardiac and respiratory activity showed that combining both rendering techniques significantly enhances the sensation of effort. Taken together, our results promote the use of our novel breathing display technique and multi-sensory rendering of physiological parameters in VR applications where effort sensations are prominent, such as for rehabilitation, sport training, or exergames.

Visual feedback improves movement illusions induced by tendon vibration after chronic stroke.

BACKGROUND: Illusion of movement induced by tendon vibration is commonly used in rehabilitation and seems valuable for motor rehabilitation after stroke, by playing a role in cerebral plasticity. The aim was to study if congruent visual cues using Virtual Reality (VR) could enhance the illusion of movement induced by tendon vibration of the wrist among participants with stroke. METHODS: We included 20 chronic stroke participants. They experienced tendon vibration of their wrist (100 Hz, 30 times) inducing illusion of movement. Three VR visual conditions were added to the vibration: a congruent moving virtual hand (Moving condition); a static virtual hand (Static condition); or no virtual hand at all (Hidden condition). The participants evaluated for each visual condition the intensity of the illusory movement using a Likert scale, the sensation of wrist's movement using a degree scale and they answered a questionnaire about their preferred condition. RESULTS: The Moving condition was significantly superior to the Hidden condition and to the Static condition in terms of illusion of movement (p < 0.001) and the wrist's extension (p < 0.001). There was no significant difference between the Hidden and the Static condition for these 2 criteria. The Moving condition was considered the best one to increase the illusion of movement (in 70% of the participants). Two participants did not feel any illusion of movement. CONCLUSIONS: This study showed the interest of using congruent cues in VR in order to enhance the consistency of the illusion of movement induced by tendon vibration among participants after stroke, regardless of their clinical severity. By stimulating the brain motor areas, this visuo-proprioceptive feedback could be an interesting tool in motor rehabilitation. Record number in Clinical Trials: NCT04130711, registered on October 17th 2019 ( https://clinicaltrials.gov/ct2/show/NCT04130711?id=NCT04130711&draw=2&rank=1 ).

Influence of the visuo-proprioceptive illusion of movement and motor imagery of the wrist on EEG cortical excitability among healthy participants.

INTRODUCTION: Motor Imagery (MI) is a powerful tool to stimulate sensorimotor brain areas and is currently used in motor rehabilitation after a stroke. The aim of our study was to evaluate whether an illusion of movement induced by visuo-proprioceptive immersion (VPI) including tendon vibration (TV) and Virtual moving hand (VR) combined with MI tasks could be more efficient than VPI alone or MI alone on cortical excitability assessed using Electroencephalography (EEG). METHODS: We recorded EEG signals in 20 healthy participants in 3 different conditions: MI tasks involving their non-dominant wrist (MI condition); VPI condition; and VPI with MI tasks (combined condition). Each condition lasted 3 minutes, and was repeated 3 times in randomized order. Our main judgment criterion was the Event-Related De-synchronization (ERD) threshold in sensori-motor areas in each condition in the brain motor area. RESULTS: The combined condition induced a greater change in the ERD percentage than the MI condition alone, but no significant difference was found between the combined and the VPI condition (p = 0.07) and between the VPI and MI condition (p = 0.20). CONCLUSION: This study demonstrated the interest of using a visuo-proprioceptive immersion with MI rather than MI alone in order to increase excitability in motor areas of the brain. Further studies could test this hypothesis among patients with stroke to provide new perspectives for motor rehabilitation in this population.

A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: Leads for future studies.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia. OBJECTIVE: This systematic review summarizes the role of rTMS in aphasia rehabilitation. METHODS: We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy. RESULTS: In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this systematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance. CONCLUSIONS: The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies.

Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study.

This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27-2.42), physical (OR 1.92, CI 95%: 1.21-3.05) and cognitive problems (OR 4.00, CI 95%: 2.34-6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21-3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI.

Care transitions in the first 6months following traumatic brain injury: Lessons from the CENTER-TBI study.

BACKGROUND: No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI). OBJECTIVES: To characterise various TBI-care pathways and the number of associated transitions during the first 6 months after TBI and to assess the impact of these on functional TBI outcome controlled for demographic and injury-related factors. METHODS: This was a cohort study of patients with TBI admitted to various trauma centres enrolled in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Number of transitions and specific care pathways were identified. Multiple logistic regression analyses were used to assess the impact of number of transitions and care pathways on functional outcome at 6 months post-injury as assessed by the Glasgow Outcome Scale-Extended (GOSE). RESULTS: In total, 3133 patients survived the acute TBI-care pathway and had at least one documented in-hospital transition at 6-month follow-up. The median number of transitions was 3 (interquartile range 2-3). The number of transitions did not predict functional outcome at 6 months (odds ratio 1.08, 95% confidence interval 1.09-1.18; P=0.063). A total of 378 different care pathways were identified; 8 were identical for at least 100 patients and characterized as "common pathways". Five of these common care pathways predicted better functional outcomes at 6 months, and the remaining 3 pathways were unrelated to outcome. In both models, increased age, violence as the cause of injury, pre-injury presence of systemic disease, both intracranial and overall injury severity, and regions of Southern/Eastern Europe were associated with unfavourable functional outcomes at 6 months. CONCLUSIONS: A high number of different and complex care pathways was found for patients with TBI, particularly those with severe injuries. This high number and variety of care pathway possibilities indicates a need for standardisation and development of "common data elements for TBI care pathways" for future studies. STUDY REGISTRATION: ClinicalTrials.gov NCT02210221.

Influence of virtual reality visual feedback on the illusion of movement induced by tendon vibration of wrist in healthy participants.

INTRODUCTION: Illusion of movement induced by tendon vibration is an effective approach for motor and sensory rehabilitation in case of neurological impairments. The aim of our study was to investigate which modality of visual feedback in Virtual Reality (VR) associated with tendon vibration of the wrist could induce the best illusion of movement. METHODS: We included 30 healthy participants in the experiment. Tendon vibration inducing illusion of movement (wrist extension, 100Hz) was applied on their wrist during 3 VR visual conditions (10 times each): a moving virtual hand corresponding to the movement that the participants could feel during the tendon vibration (Moving condition), a static virtual hand (Static condition), or no virtual hand at all (Hidden condition). After each trial, the participants had to quantify the intensity of the illusory movement on a Likert scale, the subjective degree of extension of their wrist and afterwards they answered a questionnaire. RESULTS: There was a significant difference between the 3 visual feedback conditions concerning the Likert scale ranking and the degree of wrist's extension (p<0.001). The Moving condition induced a higher intensity of illusion of movement and a higher sensation of wrist's extension than the Hidden condition (p<0.001 and p<0.001 respectively) than that of the Static condition (p<0.001 and p<0.001 respectively). The Hidden condition also induced a higher intensity of illusion of movement and a higher sensation of wrist's extension than the Static condition (p<0.01 and p<0.01 respectively). The preferred condition to facilitate movement's illusion was the Moving condition (63.3%). CONCLUSIONS: This study demonstrated the importance of carefully selecting a visual feedback to improve the illusion of movement induced by tendon vibration, and the increase of illusion by adding VR visual cues congruent to the illusion of movement. Further work will consist in testing the same hypothesis with stroke patients.

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study.

BACKGROUND: Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. OBJECTIVE: Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. METHODS: Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. RESULTS: In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). CONCLUSIONS: Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study.

OBJECTIVE: Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia. METHODS: In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question "what is your job." RESULTS: There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred. CONCLUSION: Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.