The experiences of 'Suicide Prevention Champions' in the UK National Health Service (NHS): A qualitative investigation.

Post-stroke aphasia (PSA), often results from brain lesions impacting cortical and subcortical structures, is characterized by difficulties in speech, comprehension, repetition, and naming, leading to extended hospital stays, diminished quality of life, and increased mortality []. Currently, the go-to treatment protocol for PSA is speech-language therapy (SLT), which has demonstrated beneficial effects on language function [–]. However, not all PSA patients have access to this therapy, and not all benefit from it. Despite SLT, individuals with aphasia frequently experience persistent communication challenges [,]. Thus, the development of additional, more effective therapeutic approaches for aphasia treatment is crucial. Researchers are exploring non-invasive brain stimulation (NIBS), a safe, painless, and cost-effective technique, as a potential enhancer for aphasia treatment [–]. The combination of NIBS with traditional therapy shows promise in aphasia recovery, as underscored by international guidelines [,]. Aphasia rehabilitation often targets the cerebrum, with most research focusing on stimulation of the left hemisphere due to the reactivation and utilization of the residual left-hemisphere tissue in language recovery [,–]. Some studies apply inhibitory stimulation to the right hemisphere, based on the theory of inter-hemispheric disinhibition [–]. However, there are limitations to both approaches over the cerebral hemispheres []. Stimulating the left cerebral hemisphere can be problematic, as stroke often leaves areas with low electrical resistance due to filled with cerebrospinal fluid. This reduces the stimulation exposure on the targeted tissue [–]. Conversely, inhibiting the right hemisphere might also have negative effects, as evidence suggests that it may play a compensatory role in recovering language functions after a stroke [–]. Given the variability in lesion location and size, as well as the unpredictable brain reorganization, determining the optimal stimulation strategy at the cortical level is challenging []. Hence, it’s crucial to develop novel stimulation protocols targeting other significant areas involved in language processing, thereby improving the effectiveness of PSA treatment. Recently, the cerebellum has gained attention as a new possible target for aphasia treatment [,–]. Extensive research shows that the right cerebellum significantly contributes to a variety of language functions, such as word retrieval, verbal memory, language learning and semantic processing [–]. Apart from that, the cerebellum is generally far from the usual stroke locations linked to aphasia, reducing the chance of electrical current flow being affected by encephalomalacia []. Thus, this method works well for patients with cerebrum hemisphere strokes or aphasia related to bilateral brain strokes. Recent clinical studies have indicated that stimulating the right cerebellum with NIBS can enhance speech and language therapy in PSA patients [,–], suggesting the cerebellum as an excellent site for neuromodulation in the management of PSA.