{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:24:22Z","timestamp":1790202262411,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003803","name":"University of Hong Kong","doi-asserted-by":"publisher","award":["109001214"],"award-info":[{"award-number":["109001214"]}],"id":[{"id":"10.13039\/501100003803","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: This study examined the effects of a computerized naming intervention combined with either cerebellar anodal transcranial direct-current stimulation (A-tDCS) or sham (S-tDCS) on noun and verb naming in Cantonese-speaking persons with chronic stroke-related aphasia (PWA). Methods: A double-blind, randomized, crossover, sham-controlled clinical trial was conducted with six Cantonese-speaking PWA following stroke. Participants received a 60 min computerized naming intervention incorporating audio\u2013visual speech perception cues over five consecutive days, paired with concurrent 20 min of either 2 mA cerebellar A-tDCS or S-tDCS. Generalized linear mixed-effects models (GLMM) and linear mixed-effects models (LME) were used to evaluate naming accuracy and reaction time (RT). Individual variability was further explored through single-case analyses of naming accuracy changes across conditions and grammatical categories. Results: The GLMM showed a significant three-way interaction of condition, grammatical category, and time (p &lt; 0.05). Specifically, the intervention paired with S-tDCS significantly improved verb naming, whereas A-tDCS did not induce significant improvements at the group level, effectively showing significantly smaller gains regarding verb naming compared to S-tDCS. Overall, RT decreased post-treatment across groups, but no significant differences emerged by the tDCS condition. The results support the promising efficacy of the Cantonese computerized audio\u2013visual noun and verb naming therapy. Single-case analyses revealed high inter-individual variability in response to neuromodulation effects on naming and behavioral treatment outcomes. Conclusions: This study contributes to the emerging literature on cerebellar neuromodulation in post-stroke aphasia and underscores the need for larger trials examining grammar-specific (particularly verb-related) effects and polarity-dependent outcomes. It also highlights the value of developing personalized neuromodulation protocols to optimize the efficacy of behavioral language interventions in people with aphasia.<\/jats:p>","DOI":"10.3390\/brainsci16020137","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:48:04Z","timestamp":1769590084000},"page":"137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring the Effects of a Computerized Naming Intervention Combined with Cerebellar tDCS in Cantonese-Speaking Individuals with Aphasia"],"prefix":"10.3390","volume":"16","author":[{"given":"Maria Teresa","family":"Carthery-Goulart","sequence":"first","affiliation":[{"name":"Aphasia\u00a0Research and Therapy (ART) Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"},{"name":"Speech and Neuromodulation Laboratory, Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ada","family":"Chu","sequence":"additional","affiliation":[{"name":"Aphasia\u00a0Research and Therapy (ART) Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"},{"name":"Speech and Neuromodulation Laboratory, Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6211-0358","authenticated-orcid":false,"given":"Anthony Pak-Hin","family":"Kong","sequence":"additional","affiliation":[{"name":"Aphasia\u00a0Research and Therapy (ART) Laboratory, Unit of Human Communication, Learning and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-3106","authenticated-orcid":false,"given":"Mehdi","family":"Bakhtiar","sequence":"additional","affiliation":[{"name":"Speech and Neuromodulation Laboratory, Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1016\/j.apmr.2016.03.006","article-title":"Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis","volume":"97","author":"Flowers","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1016\/j.apmr.2011.05.028","article-title":"What Are the Important Factors in Health-Related Quality of Life for People With Aphasia? A Systematic Review","volume":"93","author":"Hilari","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","first-page":"CD000425","article-title":"Speech and Language Therapy for Aphasia Following Stroke","volume":"2016","author":"Brady","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1177\/23969873241311025","article-title":"European Stroke Organisation (ESO) Guideline on Aphasia Rehabilitation","volume":"10","author":"Brady","year":"2025","journal-title":"Eur. Stroke J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1161\/STROKEAHA.109.577338","article-title":"Improvement in Aphasia Scores After Stroke Is Well Predicted by Initial Severity","volume":"41","author":"Lazar","year":"2010","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"183","DOI":"10.5853\/jos.2020.05015","article-title":"Current Approaches to the Treatment of Post-Stroke Aphasia","volume":"23","author":"Fridriksson","year":"2021","journal-title":"J. Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s40141-020-00257-5","article-title":"Neuromodulation in Post-Stroke Aphasia Treatment","volume":"8","author":"Breining","year":"2020","journal-title":"Curr. Phys. Med. Rehabil. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Meinzer, M., Lindenberg, R., Sieg, M.M., Nachtigall, L., Ulm, L., and Fl\u00c3\u00b6el, A. (2014). Transcranial Direct Current Stimulation of the Primary Motor Cortex Improves Word-Retrieval in Older Adults. Front. Aging Neurosci., 6.","DOI":"10.3389\/fnagi.2014.00253"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12984-020-00708-z","article-title":"Transcranial Direct Current Stimulation (TDCS) for Improving Aphasia after Stroke: A Systematic Review with Network Meta-Analysis of Randomized Controlled Trials","volume":"17","author":"Elsner","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bakhtiar, M., Carthery-Goulart, M.T., and Kong, A.P.-H. (2023). Neuromodulation of Impaired Spoken Discourse. Spoken Discourse Impairments in the Neurogenic Populations, Springer International Publishing.","DOI":"10.1007\/978-3-031-45190-4_20"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/j.1469-7793.2000.t01-1-00633.x","article-title":"Excitability Changes Induced in the Human Motor Cortex by Weak Transcranial Direct Current Stimulation","volume":"527","author":"Nitsche","year":"2000","journal-title":"J. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S1567-424X(09)70229-6","article-title":"Chapter 26 Transcranial Direct Current Stimulation (tDCS)","volume":"56","author":"Paulus","year":"2003","journal-title":"Suppl. Clin. Neurophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.rehab.2015.04.009","article-title":"Mechanisms Underlying Transcranial Direct Current Stimulation in Rehabilitation","volume":"58","author":"Roche","year":"2015","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_14","first-page":"CD009760","article-title":"Transcranial Direct Current Stimulation (TDCS) for Improving Aphasia in Adults with Aphasia after Stroke","volume":"2019","author":"Elsner","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.brs.2010.11.001","article-title":"Individualized Model Predicts Brain Current Flow during Transcranial Direct-Current Stimulation Treatment in Responsive Stroke Patient","volume":"4","author":"Datta","year":"2011","journal-title":"Brain Stimul."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.nicl.2017.04.014","article-title":"The Impact of Large Structural Brain Changes in Chronic Stroke Patients on the Electric Field Caused by Transcranial Brain Stimulation","volume":"15","author":"Minjoli","year":"2017","journal-title":"Neuroimage Clin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"19430","DOI":"10.1038\/s41598-023-45905-7","article-title":"The Impact of Brain Lesions on TDCS-Induced Electric Fields","volume":"13","author":"Evans","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Liu, Q., Liu, Y., and Zhang, Y. (2024). Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review. Biomedicines, 12.","DOI":"10.3390\/biomedicines12061348"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s12311-022-01464-7","article-title":"Effects of Cerebellar Transcranial Direct Current Stimulation in Patients with Stroke: A Systematic Review","volume":"22","author":"Li","year":"2022","journal-title":"Cerebellum"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S1364-6613(98)01211-X","article-title":"Neuroimaging Studies of the Cerebellum: Language, Learning and Memory","volume":"2","author":"Desmond","year":"1998","journal-title":"Trends Cogn. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.neulet.2018.07.005","article-title":"The Cerebellum and Cognition","volume":"688","author":"Schmahmann","year":"2019","journal-title":"Neurosci. Lett."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1007\/s12311-011-0260-7","article-title":"The Cerebellum and Cognition: Evidence from Functional Imaging Studies","volume":"11","author":"Stoodley","year":"2012","journal-title":"Cerebellum"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.neuron.2013.10.044","article-title":"The Cerebellum and Cognitive Function: 25 Years of Insight from Anatomy and Neuroimaging","volume":"80","author":"Buckner","year":"2013","journal-title":"Neuron"},{"key":"ref_24","first-page":"491","article-title":"Cerebellar TDCS as a Novel Treatment for Aphasia? Evidence from Behavioral and Resting-State Functional Connectivity Data in Healthy Adults","volume":"34","author":"Turkeltaub","year":"2016","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sebastian, R., Saxena, S., Tsapkini, K., Faria, A.V., Long, C., Wright, A., Davis, C., Tippett, D.C., Mourdoukoutas, A.P., and Bikson, M. (2017). Cerebellar TDCS: A Novel Approach to Augment Language Treatment Post-Stroke. Front. Hum. Neurosci., 10.","DOI":"10.3389\/fnhum.2016.00695"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/WNN.0000000000000270","article-title":"An Exploratory Study of Cerebellar Transcranial Direct Current Stimulation in Individuals With Chronic Stroke Aphasia","volume":"34","author":"DeMarco","year":"2021","journal-title":"Cogn. Behav. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1162\/jocn_a_01201","article-title":"Transcranial Cerebellar Direct Current Stimulation Enhances Verb Generation but Not Verb Naming in Poststroke Aphasia","volume":"30","author":"Marangolo","year":"2018","journal-title":"J. Cogn. Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"fcaa179","DOI":"10.1093\/braincomms\/fcaa179","article-title":"Cerebellar Neuromodulation Improves Naming in Post-Stroke Aphasia","volume":"2","author":"Sebastian","year":"2020","journal-title":"Brain Commun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1080\/02687038.2024.2328874","article-title":"Cerebellar TDCS Enhances Functional Communication Skills in Chronic Aphasia","volume":"38","author":"Kim","year":"2024","journal-title":"Aphasiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"6898","DOI":"10.1038\/s41598-025-90927-y","article-title":"Cerebellar Transcranial Direct Current Stimulation Improves Quality of Life in Individuals with Chronic Poststroke Aphasia","volume":"15","author":"Zheng","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Coemans, S., Struys, E., Tsapkini, K., Paquier, P., Vandenborre, D., and Keulen, S. (2023). Case Report: The Effects of Cerebellar TDCS in Bilingual Post-Stroke Aphasia. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1173178"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"105617","DOI":"10.1016\/j.bandl.2025.105617","article-title":"Modulating Language and Executive Functions in Bilingual Aphasia with Cerebellar TDCS: A Case Series","volume":"269","author":"Coemans","year":"2025","journal-title":"Brain Lang."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1161\/STROKEAHA.108.532499","article-title":"Treating Visual Speech Perception to Improve Speech Production in Nonfluent Aphasia","volume":"40","author":"Fridriksson","year":"2009","journal-title":"Stroke"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1161\/STROKEAHA.110.600288","article-title":"Transcranial Direct Current Stimulation Improves Naming Reaction Time in Fluent Aphasia","volume":"42","author":"Fridriksson","year":"2011","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1001\/jamaneurol.2018.2287","article-title":"Transcranial Direct Current Stimulation vs Sham Stimulation to Treat Aphasia After Stroke","volume":"75","author":"Fridriksson","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3233\/NRE-141199","article-title":"Feasibility of Using High-Definition Transcranial Direct Current Stimulation (HD-TDCS) to Enhance Treatment Outcomes in Persons with Aphasia","volume":"36","author":"Richardson","year":"2015","journal-title":"NeuroRehabilitation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.3233\/ADR-240034","article-title":"Effects of Cerebellar Transcranial Direct Current Stimulation in Bilingual Logopenic Primary Progressive Aphasia","volume":"8","author":"Coemans","year":"2024","journal-title":"J. Alzheimers Dis. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/0911-6044(92)90025-R","article-title":"Linguistic Assessment of Chinese-Speaking Aphasics: Development of a Cantonese Aphasia Battery","volume":"7","author":"Yiu","year":"1992","journal-title":"J. Neurolinguist."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0911-6044(98)00023-2","article-title":"Description of a Set of 164 Nouns and 102 Verbs Matched for Printed Word Frequency, Familiarity and Age of Acquisition","volume":"11","author":"Masterson","year":"1988","journal-title":"J. Neurolinguist."},{"key":"ref_40","unstructured":"Druks, J.M.J. (2000). An Object and Action Naming Battery, Psychology Press."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"116","DOI":"10.3758\/BF03195503","article-title":"A Windows Display Program with Millisecond Accuracy","volume":"35","author":"Forster","year":"2003","journal-title":"Behav. Res. Methods Instrum. Comput."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.3758\/s13428-020-01521-1","article-title":"Picture Naming in Bilingual and Monolingual Chinese Speakers: Capturing Similarity and Variability","volume":"53","author":"Momenian","year":"2021","journal-title":"Behav. Res. Methods"},{"key":"ref_43","first-page":"9","article-title":"Pain in Children: Comparison of Assessment Scales","volume":"14","author":"Wong","year":"1988","journal-title":"Pediatr. Nurs."},{"key":"ref_44","unstructured":"R Core Team (2023). A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.jml.2007.12.005","article-title":"Mixed-Effects Modeling with Crossed Random Effects for Subjects and Items","volume":"59","author":"Baayen","year":"2008","journal-title":"J. Mem. Lang."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jml.2012.11.001","article-title":"Random Effects Structure for Confirmatory Hypothesis Testing: Keep It Maximal","volume":"68","author":"Barr","year":"2013","journal-title":"J. Mem. Lang."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.brs.2017.04.003","article-title":"Response Variability of Different Anodal Transcranial Direct Current Stimulation Intensities across Multiple Sessions","volume":"10","author":"Ammann","year":"2017","journal-title":"Brain Stimul."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.neures.2020.06.002","article-title":"The Effects of Transcranial Direct Current Stimulation on Corticospinal and Cortico-Cortical Excitability and Response Variability: Conventional versus High-Definition Montages","volume":"166","author":"Pellegrini","year":"2021","journal-title":"Neurosci. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"108206","DOI":"10.1016\/j.neuropsychologia.2022.108206","article-title":"Cerebellar TDCS Does Not Modulate Language Processing Performance in Healthy Individuals","volume":"169","author":"Bongaerts","year":"2022","journal-title":"Neuropsychologia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.neuroimage.2015.01.033","article-title":"Determinants of the Electric Field during Transcranial Direct Current Stimulation","volume":"109","author":"Opitz","year":"2015","journal-title":"Neuroimage"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.brs.2012.03.006","article-title":"Task-Specific Facilitation of Cognition by Cathodal Transcranial Direct Current Stimulation of the Cerebellum","volume":"5","author":"Pope","year":"2012","journal-title":"Brain Stimul."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12311-017-0877-2","article-title":"Targeting the Human Cerebellum with Transcranial Direct Current Stimulation to Modulate Behavior: A Meta-Analysis","volume":"17","author":"Oldrati","year":"2018","journal-title":"Cerebellum"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.clinph.2015.11.012","article-title":"A Technical Guide to TDCS, and Related Non-Invasive Brain Stimulation Tools","volume":"127","author":"Woods","year":"2016","journal-title":"Clin. Neurophysiol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Papageorgiou, G., Kasselimis, D., Angelopoulou, G., Laskaris, N., Tsolakopoulos, D., Velonakis, G., Tountopoulou, A., Vassilopoulou, S., and Potagas, C. (2023). Investigating Aphasia Recovery: Demographic and Clinical Factors. Brain Sci., 14.","DOI":"10.3390\/brainsci14010007"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.neubiorev.2010.04.007","article-title":"Nouns and Verbs in the Brain: A Review of Behavioural, Electrophysiological, Neuropsychological and Imaging Studies","volume":"35","author":"Vigliocco","year":"2011","journal-title":"Neurosci. Biobehav. Rev."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/2\/137\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:06:32Z","timestamp":1769591192000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/2\/137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":55,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["brainsci16020137"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16020137","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]}}}