{"title":"fNIRS-Guided neuronavigated rTMS augments naming recovery in subacute post-stroke aphasia: a double-blind randomized controlled trial.","authors":"Haozheng Li, Dongxiang Fang, Yihao Chen, Shuqi Xu, Ying Wang, Wenwen Wei, Ruofan Zhao, Yixian Lai, Yi Wu, Qing Yang, Ruiping Hu","doi":"10.3389/fnhum.2026.1810169","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Selecting an optimal stimulation target is a persistent barrier to maximizing the efficacy of repetitive transcranial magnetic stimulation (rTMS) for subacute post-stroke aphasia. This trial evaluated an individualized, fNIRS-based targeting strategy derived from task-evoked activation during picture naming.</p><p><strong>Methods: </strong>We conducted a double-blind, randomized, sham-controlled clinical trial. Patients with first-ever left-hemispheric stroke and subacute aphasia (1-6 months post-onset; 35-80 years) were recruited at Huashan Hospital (2021-2023) and randomized 1:1 to receive fNIRS-guided active rTMS or fNIRS-guided sham stimulation, in addition to 3 weeks of intensive speech-language therapy. Individual targets were defined as the fNIRS channel showing the strongest picture-naming task activation and were delivered under neuronavigation. Active stimulation used 10 Hz, 80% resting motor threshold, 2,000 pulses per session, for 15 sessions (3 weeks); sham used an identical schedule with a sham configuration. Primary/secondary outcomes included the Chinese Boston Naming Test (BNT), WAB-R indices, picture-naming behavioral performance, and task/resting-state fNIRS measures.</p><p><strong>Results: </strong>Twenty-eight participants were enrolled and 27 completed the protocol (active rTMS: <i>n</i> = 14; sham: <i>n</i> = 13). Language performance improved over time in both groups; however, active rTMS produced significantly larger gains in confrontation naming on the BNT (Time × Group: <i>F</i> = 16.04, <i>p</i> < 0.01) and higher picture-naming accuracy (Time × Group: <i>F</i> = 20.10, <i>p</i> < 0.01), with an additional advantage on the WAB-R naming subscore (Time × Group: <i>F</i> = 4.44, <i>p</i> < 0.05). Neurophysiologically, task-based fNIRS indicated increased activation in the left dorsolateral prefrontal cortex and left Broca's area after active treatment, accompanied by strengthened resting-state connectivity between these regions; connectivity change was positively correlated with BNT improvement (<i>r</i> = 0.6405, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>fNIRS-guided rTMS protocol based on individualized, task-evoked activation mapping is a safe and effective approach for improving picture-naming performance in patients with subacute post-stroke aphasia. The intervention yields promising short-term therapeutic benefits and is associated with enhanced activation in the left dorsolateral prefrontal cortex and Broca's area, as well as strengthened functional connectivity between these language-related regions.</p><p><strong>Clinical trial registration: </strong>https://www.chictr.org.cn/showproj.html?proj=61768, Unique identifier: ChiCTR2000038515.</p>","PeriodicalId":12536,"journal":{"name":"Frontiers in Human Neuroscience","volume":"20 ","pages":"1810169"},"PeriodicalIF":2.7000,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144099/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Human Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fnhum.2026.1810169","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Selecting an optimal stimulation target is a persistent barrier to maximizing the efficacy of repetitive transcranial magnetic stimulation (rTMS) for subacute post-stroke aphasia. This trial evaluated an individualized, fNIRS-based targeting strategy derived from task-evoked activation during picture naming.
Methods: We conducted a double-blind, randomized, sham-controlled clinical trial. Patients with first-ever left-hemispheric stroke and subacute aphasia (1-6 months post-onset; 35-80 years) were recruited at Huashan Hospital (2021-2023) and randomized 1:1 to receive fNIRS-guided active rTMS or fNIRS-guided sham stimulation, in addition to 3 weeks of intensive speech-language therapy. Individual targets were defined as the fNIRS channel showing the strongest picture-naming task activation and were delivered under neuronavigation. Active stimulation used 10 Hz, 80% resting motor threshold, 2,000 pulses per session, for 15 sessions (3 weeks); sham used an identical schedule with a sham configuration. Primary/secondary outcomes included the Chinese Boston Naming Test (BNT), WAB-R indices, picture-naming behavioral performance, and task/resting-state fNIRS measures.
Results: Twenty-eight participants were enrolled and 27 completed the protocol (active rTMS: n = 14; sham: n = 13). Language performance improved over time in both groups; however, active rTMS produced significantly larger gains in confrontation naming on the BNT (Time × Group: F = 16.04, p < 0.01) and higher picture-naming accuracy (Time × Group: F = 20.10, p < 0.01), with an additional advantage on the WAB-R naming subscore (Time × Group: F = 4.44, p < 0.05). Neurophysiologically, task-based fNIRS indicated increased activation in the left dorsolateral prefrontal cortex and left Broca's area after active treatment, accompanied by strengthened resting-state connectivity between these regions; connectivity change was positively correlated with BNT improvement (r = 0.6405, p < 0.05).
Conclusion: fNIRS-guided rTMS protocol based on individualized, task-evoked activation mapping is a safe and effective approach for improving picture-naming performance in patients with subacute post-stroke aphasia. The intervention yields promising short-term therapeutic benefits and is associated with enhanced activation in the left dorsolateral prefrontal cortex and Broca's area, as well as strengthened functional connectivity between these language-related regions.
期刊介绍：
Frontiers in Human Neuroscience is a first-tier electronic journal devoted to understanding the brain mechanisms supporting cognitive and social behavior in humans, and how these mechanisms might be altered in disease states. The last 25 years have seen an explosive growth in both the methods and the theoretical constructs available to study the human brain. Advances in electrophysiological, neuroimaging, neuropsychological, psychophysical, neuropharmacological and computational approaches have provided key insights into the mechanisms of a broad range of human behaviors in both health and disease. Work in human neuroscience ranges from the cognitive domain, including areas such as memory, attention, language and perception to the social domain, with this last subject addressing topics, such as interpersonal interactions, social discourse and emotional regulation. How these processes unfold during development, mature in adulthood and often decline in aging, and how they are altered in a host of developmental, neurological and psychiatric disorders, has become increasingly amenable to human neuroscience research approaches. Work in human neuroscience has influenced many areas of inquiry ranging from social and cognitive psychology to economics, law and public policy. Accordingly, our journal will provide a forum for human research spanning all areas of human cognitive, social, developmental and translational neuroscience using any research approach.
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