Abstract: Objective  To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) targeting the cerebellum on the rehabilitation of language function, non-verbal cognitive function, and activities of daily living in patients with post-stroke aphasia (PSA), and compare its efficacy with rTMS targeting Broca’s mirror area in the right cerebral hemisphere, so as to provide a theoretical basis for optimizing clinical rehabilitation regimens for patients with PSA.
Methods  This study adopted a randomized controlled clinical trial design. Patients with PSA caused by lesions in the left cerebral hemisphere (dominant hemisphere) who received inpatient rehabilitation at the Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University between October 2023 and December 2024 were consecutively enrolled. They were randomly divided into three groups according to the random sequence generated by statistical software: the group receiving rTMS targeting the right‑hemispheric homologue of Broca’s area (referred to as the cerebral target group), the group receiving rTMS targeting the contralesional cerebellum (referred to as the cerebellar target group), and the control group. Both the cerebral target group and the cerebellar target group received speech and language rehabilitation training: rTMS was delivered to the corresponding target sites first, followed by speech-language therapy (SLT). The rTMS parameters were set as follows: frequency 1 Hz, intensity 110% of the resting motor threshold of the unaffected cerebral hemisphere, duration 18 s, 18 pulses per train, inter-train interval 2 s, 60 repetitions, with a total of 1080 pulses. Treatments were conducted twice daily (morning and afternoon); each session included a 20-minute rTMS intervention followed by 30-minute SLT, totaling 50 min per training session, 5 days per week for a 2-week treatment course. The control group only received SLT twice daily (30 min each session), 5 days per week over 2 weeks. The differences in language function within and between groups before and after treatment were assessed using the western aphasia battery (WAB); the differences in non-verbal cognitive function were assessed using the Loewenstein occupational therapy cognitive assessment (LOTCA); and the differences in activities of daily living were assessed using the activity of daily living scale (ADL). 
Results  A total of 77 patients with PSA were finally enrolled in this study, including 55 males: 25 patients in the cerebral target group, 26 patients in the cerebellar target group, and 26 patients in the control group. After treatment, the language function in the cerebellar target group was significantly improved relative to baseline (P<0.05). Improvements were significantly greater in the cerebellar target group than in the control group (P<0.05), while no inter-group difference in language function improvement was detected between the cerebellar target group and the cerebral target group (P>0.05). After treatment, non-verbal cognitive function in the cerebellar target group was significantly improved from baseline (P<0.05). Compared with the control group and the cerebral target group, the cerebellar target group showed significantly better improvements (P<0.05). After treatment, the activities of daily living in the cerebellar target group were significantly improved compared with those at baseline (P<0.05). Compared with both the control group and the cerebral target group, the cerebellar target group demonstrated significantly better improvements (P<0.05).
Conclusions  Both the right‑hemispheric homologue of Broca’s area and the contralesional cerebellum are effective targets of short‑term low‑frequency rTMS for improving language function in patients with PSA. They exert equivalent therapeutic effects for improving language function and can both be used for language rehabilitation in patients with PSA; when combined with SLT, both targets produce superior efficacy compared with SLT alone. Similarly, the contralesional cerebellum is also an effective target of short‑term low‑frequency rTMS for improving non‑linguistic cognitive functions and activities of daily living in PSA patients, with effects superior to those of the right‑hemispheric homologue of Broca’s area.

Key words: Post-stroke aphasia; Repetitive transcranial magnetic stimulation; Cerebellum; Rehabilitation

摘要： 目的 探讨以小脑为靶点的重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）技术在卒中后失语（post-stroke aphasia，PSA）患者语言功能、非语言认知功能及日常生活能力康复中的作用，并与Broca区在右侧大脑半球的镜像区靶点进行对比，为临床优化PSA的康复治疗方案提供理论依据。
方法 本研究为随机对照临床试验，连续纳入2023年10月—2024年12月在首都医科大学附属北京天坛医院康复医学科住院治疗的左侧大脑半球（优势半球）PSA患者。将其按照统计学软件产生的随机序列分为3组：以Broca区在右侧大脑半球的镜像区为靶点组（即大脑靶点组）、以病灶对侧小脑为靶点组（即小脑靶点组）和对照组。大脑靶点组和小脑靶点组均接受语言康复训练［给予相应部位的rTMS治疗（频率为1 Hz，强度为健侧大脑半球静息运动阈值的110%，持续时间为18 s，脉冲数为18个，每18个脉冲为1串，串间隔为2 s，重复次数为60次，脉冲总数为1080个）后再进行言语-语言治疗（speech-language therapy，SLT）］，每日上午、下午各进行1次，其中rTMS治疗20 min，SLT 30 min，总计50 min，每周治疗5 d，为期2周。对照组仅每日上午、下午各进行1次SLT，每次30 min，每周进行5 d，为期2周。采用西部失语症成套测验（western aphasia battery，WAB）比较组内及组间治疗前后语言功能的差异，采用洛文斯顿作业疗法认知评定成套测验（Loewenstein occupational therapy cognitive assessment，LOTCA）比较非语言认知功能的差异，采用日常生活能力量表（activity of daily living scale，ADL）比较日常生活能力的差异。
结果 本研究最终纳入77例PSA患者，男性55例，其中大脑靶点组25例，小脑靶点组26例，对照组26例。治疗后，小脑靶点组的语言功能较治疗前有所改善（P＜0.05）；与对照组相比，小脑靶点组的改善更明显（P＜0.05）；与大脑靶点组相比，小脑靶点组各项得分改善均无统计学意义（P＞0.05）。治疗后，小脑靶点组的非语言认知功能较治疗前有所改善（P＜0.05）；与对照组相比，小脑靶点组的改善更明显（P＜0.05）；与大脑靶点组相比，小脑靶点组的改善更明显（P＜0.05）。治疗后，小脑靶点组的日常生活能力较治疗前有所改善（P＜0.05）；与对照组相比，小脑靶点组的改善更明显（P＜0.05）；与大脑靶点组相比，小脑靶点组的改善更明显（P＜0.05）。
结论 Broca区在右侧大脑半球的镜像区与病灶对侧小脑均为短期低频rTMS改善PSA患者语言功能的有效刺激靶点，二者疗效相近，均可用于PSA的语言康复治疗，联合SLT的疗效均优于单纯SLT。同样地，病灶对侧小脑也是短期低频rTMS改善PSA患者非语言认知功能和日常生活能力的有效刺激靶点，且疗效优于Broca区在右侧大脑半球的镜像区。

关键词: 卒中后失语; 重复经颅磁刺激; 小脑; 康复