TMS in Aphasia Recovery

Inclusion criteria

• Aphasic patients will have had single, unilateral left hemisphere ischemic stroke, which spared the supplementary motor area (SMA)
• With the exception of lacunar infarcts less than ≤ 1.5 cm (as measured by neuroimaging), the stroke causing the patients' impairments must be the only stroke.
• Aphasic patients will be at least 6 months post-stroke and have mild-severe, non-fluent speech
• Participants must be able to understand the nature of the study, and give informed consent

Exclusion criteria

• Patients with more than one stroke
• Primary hemorrhagic stroke. Note: It is recognized that some ischemic strokes may have a minor amount of hemosiderin in the parenchyma. If this occurs, this is not considered a "hemorrhagic stroke" referred to in this exclusion criterion.
• Intracranial metallic bodies from prior neurosurgical procedure
• Signs of increased intracranial pressure as assessed by ophthalmic exam and patient symptoms
• Implanted pacemaker, medication pump, vagal nerve stimulator, deep brain stimulator, TENS unit or ventriculoperitoneal shunt
• History of seizure or unexplained loss of consciousness during the year prior to the initiation of the study
• Pregnancy. If the patient cannot rule out pregnancy then a pregnancy test will be conducted prior to inclusion into the study
• Family history of epilepsy
• Acute, unstable medical conditions
• History of substance abuse within the last 6 months
• Abnormal neurologic exam other than as signs of the condition studied in the present protocol
• History of known structural brain abnormality other than as signs of the condition studied in the present protocol
• History of tinnitus
• History of bipolar disorder
• Consumption of medicines known to lower the seizure threshold
• History of head injury with unconsciousness lasting more than 5 minutes
• Previous brain surgery
• Other medical or neurologic conditions, aside from stroke, in which the likelihood of developing a seizure is known to be increased
• Other medical or neurologic conditions, in which a seizure would be particularly harmful
• Significant cardiac disease
• Intracardiac lines of any type
• Current serious or unstable medical illness, including renal, hepatic, cardiovascular, gastrointestinal, endocrinologic, neurologic, immunologic, or hematological disease, that could require admission to a hospital within 3 months, or that death is anticipated within 3 years, or that requires daily supervision by a health professional
• Administration of any investigational drug within 5 half-lives of the drug prior to testing