The Feasibility and Scalability of Home-Based and Remotely Supervised tDCS in a Multi-Center Sham-Controlled Randomized Clinical Trial

This study aims to evaluate the feasibility of a home-based, remotely supervised (RS) tDCS protocol [9,10] paired with SLT to address these limitations and improve language outcomes.Methods A 73-year-old male with lvPPA participated in this study.He underwent 20 daily sessions of RS-tDCS (2.0 mA for 20 minutes) targeting the left inferior frontal gyrus, paired with 45 minutes of personalized word retrieval training following a modified version of the Lexical Retrieval Cascade Treatment [11].The intervention was conducted at home, 5 days per week for 4 weeks (Monday to Friday), with real-time monitoring via HIPAAcompliant video visits.Language assessments were performed before and after the intervention using the Western Aphasia Battery-Revised (WAB-R) [12] and self-report questionnaires on quality of life and communication abilities.The tDCS equipment, including a 1x1 mini-CT tDCS device, SNAPstrap headset (F7 anode, O1 cathode), and single-use SNAPpad sponge electrodes, was shipped to the patient.Each session began with a clearance and confirmation of headset placement, followed by activation of the tDCS device and initiation of word naming practice. ResultsThe patient completed all 20 sessions as scheduled, reporting only mild and transient adverse events such as brief tingling at the electrode site.Post-intervention assessments showed improvements in language outcomes, including an increase in the WAB-R Aphasia Quotient from 72.0 to 74.9 and in Auditory Verbal Comprehension from 7.3 to 9.0.Spontaneous speech, repetition, and naming and word-finding remained stable.The patient identified more trained items (22/30) compared to untrained items (18/30), indicating a modest benefit from repetitive exposure.Self-reported measures of quality of life and communication abilities, including the SAQOL-39 and PROMIS scales, remained stable, with no significant adverse events reported.Discussion This case study highlights the feasibility and potential benefits of homebased RS-tDCS paired with SLT in managing PPA.The improvements in language function observed in this patient support the potential for tDCS to augment traditional SLT, offering a promising approach for patients with PPA.The protocol's success in a home setting suggests that this approach could be accessible to a broader range of patients, overcoming geographic and logistical barriers.Further investigation through larger randomized controlled trials is warranted to validate these findings, optimize treatment protocols, and establish standardized guidelines for clinical application [13].