主概念分析法用于失语症语料评估:基于常人对照的命名性失语语料研究

目的:探讨主概念分析法(MCA)在命名性失语语料分析中的有效性,并分析语料类型对该方法有效性的影响。方法:采集27例健康人和11例命名性失语患者在单图描述和组图叙事中的多媒体语料,根据健康人语料建立两种语料任务的主概念清单,对病例组和对照组进行主概念评分,比较两组的各主概念指标差异,分析语料类型对言语产出的影响,并探讨主概念分析法的评分者间信度和评分者内部信度。结果:在两种语料任务的主概念分析中,病例组的AC(准确且完整)、MC总分(主概念总分)均显著低于对照组(P<0.05),AI(准确且不完整)、AB(缺失)均显著高于对照组(P<0.05)。在单图描述的主概念分析中,病例组的IN(错误)显著高于对照组(P<0.05)。两种语料类型中,患者的MC总分均与失语商呈显著正相关。病例组和对照组在单图描述中的标准化AC、标准化MC总分均明显低于组图叙事(P<0.05)。主概念分析法在语料评估中有良好的评估者间信度和评估者内部信度。结论:主概念分析法可有效评价命名性失语的言语障碍,可为临床失语症的语料评估和分析提供新途径。     

不同话语类型影响词汇多样性和词类分布：基于普通话失语库平台的常人研究

目的:初步构建普通话失语库常人数据集,探讨其中不同话语类型的言语产出。方法:根据国际失语库测试标准,采集30例健康人在不同任务类型中的多媒体话语材料,采用CLAN软件进行转录、编码和校验,并对不同话语类型的词汇多样性及词类分布进行统计分析。结果:命题故事的词汇多样性显著高于组图叙事和单图描述;三种话语类型的词类均以动词产出量最多,其次是名词;不同的话语类型具有不同的词类分布模式。结论:话语类型能影响健康人话语的词汇多样性和词类分布,据此可为言语障碍患者在会话水平的评估和干预提供指导。     

命名性失语的汉语普通话语料库构建

目的:以命名性失语症为例,构建符合国际失语库标准的普通话失语症语料数据集。方法:根据国际失语库标准,采集9例命名性失语症患者自发性言语的多媒体样本,采用CLAN软件进行转录、编码和校验,并对所建立的样本数据集进行语言分析。结果:在失语库测试的整体水平,患者产生句子数96.89±22.45,耗时为709.1±283.78s,词类187.2±58.89个,词次563.67±286.15个,名词103±56.39个,动词99.67±44.65个。在单项语言任务水平,这些参数还支持语言任务间比较。在看图说话和命题任务中,名词和动词的产出量呈显著正相关(n=9,r=0.765,P0.05;n=9,r=0.945,P0.001);在命题任务中,动词的产出量与AQ值呈显著正相关(n=9,r=0.686,P0.05)。结论:命名性失语症患者名词和动词的产出量相同,动词更能反映言语改善程度。国际失语库为汉语失语症提供了有效的语料分析工具。     

进阶式言语训练对基底节性失语的康复效果

目的：探讨进阶式言语训练法对脑卒中后基底节性失语症患者的康复效果。方法：选取基底节性失语症 患者18例,随机分为对照组和治疗组,各9例。对照组给予传统语言康复,治疗组给予进阶式言语训练法,均 治疗3周。于治疗前、后,采用波士顿诊断性失语检查法（BDAE）及西方失语测验量表（WAB）评价2组患者的 失语程度及言语功能。出院后随访3个月,采用BDAE量表评估失语程度并判定康复疗效。结果：治疗后,2 组的BDAE分级均较治疗前升高,且治疗组的BDAE分级高于对照组（P＜0.05）;2组的WAB量表各项评分均 高于同组治疗前（P＜0.05）,且治疗组自发言语（信息量及流畅度）得分高于对照组（P＜0.05）。随访3个月后, 2组的BDAE分级继续提高,治疗组的总有效率（88.89%）高于对照组的总有效率（77.78%）,但2组间差异均无 统计学意义（均P＞0.05）。结论：进阶式言语训练有助于改善卒中后基底节性失语症患者的言语功能。     

慢性非流畅性失语患者语言加工特征的脑磁图研究

目的:研究慢性非流畅性失语患者大脑在图片命名过程中神经网络活动特征及与受损语言功能的关系.方法:非流畅性失语患者及年龄、性别、学历相匹配的健康成年人各5例,分别作为实验组和对照组.使用西方失语症成套测验评估受试者的言语功能,应用脑磁图(MEG)对受试者图片命名过程中大脑语言加工活动进行检测.结果:比较两组受试者在图片命名过程中相关大脑感兴趣区域(ROIs)在不同时间窗内的激活强度后发现:在图片命名的400-600ms时间窗内非流畅性失语症患者左脑Broca区的激活强度较对照组显著下降(P＜0.05),右脑的Broca同源区、Wemicke同源区、顶下小叶激活强度显著高于对照组(P＜0.05),右Broca同源区的激活强度与患者的失语商(AQ)正相关(r=0.886,n=5,P=-0.045).结论:慢性非流畅性失语患者存在右脑神经网络活动广泛上调,这种泛化在言语输出准备时期最为明显,提示与受损后大脑自发低水平的言语代偿有关.     

Schuell刺激联合针刺治疗脑卒中后运动性失语的疗效观察

目的：探讨Schuell刺激疗法配合针刺法对中风后运动性失语患者语言功能的影响。方法：60例中风后运动性失语患者按随机分为观察组与对照组各30例。2组均采用Schuell刺激疗法,观察组加用针刺法。训练前后采用西方失语症成套测验（WAB）评价患者语言功能。结果：治疗36d后,2组自发言语、口语理解、复述、命名等WAB各项评分及AQ评分均较治疗前明显提高（P＜0．01）,且观察组更高于对照组（P＜0．05）。结论：Schuell刺激疗法配合针刺法对脑卒中后运动性失语的语言功能有积极作用,且提示对自发言语、复述、命名等言语症状有治疗优势。     

智能有声挂图对脑卒中运动性失语患者语言康复训练效果的影响

目的 探讨智能有声挂图结合语言康复训练对脑卒中运动性失语患者的疗效.方法 根据入组时间顺序进行编号排序,采用随机数字表,将86例脑卒中后运动性失语患者随机分为对照组和研究组各43例.对照组采用脑卒中常规护理,研究组在脑卒中常规护理的基础上给予智能有声挂图结合语言训练的方法进行综合训练.失语程度评定采用失语症严重程度分级标准（BDAE）,疗效评定采用北京大学汉语失语症检查法,语言功能评定采用北京医院“汉语失语症检查法”评定.两组患者在训练前及训练3个月后分别进行评定,比较两组的差异.结果 训练前两组患者失语程度、语言功能评分比较差异无统计学意义（P＞0.05）.经过3个月的训练,研究组的语言功能评分为（164.59 ±9.48）分,明显高于对照组的（138.42±9.60）分,差异有统计学意义（t=155.72,P＜0.01）.两组患者训练后失语程度比较研究组疗效优于对照组,差异有统计学意义（P＜0.01）.研究组训练后总有效率为88.37％（38/43）,对照组为62.79％ （27/43）,差异有统计学意义（x2 =7.623,P＜0.01）.结论 采用智能有声挂图结合语言训练对脑卒中运动性失语患者语言功能的恢复有显著疗效.     

音乐疗法联合语言训练对脑卒中后非流畅性失语的 疗效研究

目的：观察音乐疗法联合常规语言治疗对脑卒中后非流畅性失语患者语言功能恢复的影响。方法： 将37例符合纳入条件的脑卒中后非流畅性失语患者随机分为观察组（19例）和对照组（18例）,2组患者均 接受常规药物治疗及肢体康复治疗,观察组在此基础上每天接受30 min音乐疗法和30 min常规语言治疗, 对照组每天接受1 h常规语言治疗,每周治疗5 d。治疗前及治疗4周后,采用西方失语成套测验（WAB）汉 化版口语部分与Goodglass-Kaplan失语症严重程度分级标准（ASRS）评定患者语言功能。结果：治疗后,2 组WAB各项评分及ASRS评级均较治疗前改善（P＜0.01）。治疗后,观察组流畅度,复述,命名及失语指数 （AQ）评分均优于对照组（P＜0.05）,但2组患者信息量、自发言语、听理解评分及ASRS评级组间差异无统 计学意义（P＞0.05）。结论：音乐疗法联合常规语言治疗能有效改善脑卒中后非流畅性失语患者的语言功 能,尤其是言语流畅度,复述及命名能力。     

经颅直流电刺激结合头皮针治疗脑卒中运动性失语患者的疗效观察

目的：探讨经颅直流电刺激（tDCS）左背外侧前额叶结合头皮针对脑卒中运动性失语患者的临床疗效。方法：选取74例脑卒中运动性失语患者,随机分为观察组和对照组,每组各37例。对照组给予言语训练及头针治疗,同时给予tDCS伪刺激治疗,观察组在给予言语训练及头针治疗的同时联合tDCS治疗,共治疗4周。2组患者于治疗前后采用中国康复研究中心汉语标准失语症检查量表（CRRCAE）、波士顿诊断性失语症测验（BDAE）评估患者的语言功能,采用采用日常生活交流能力量表（CADL）评定患者语言交流能力,采用简明健康调查量表（SF-36）评定患者的生存质量。结果：2组患者治疗前CRRCAE评分、BDAE等级、CADL评分、SF-36评分比较差异无统计学意义。治疗4周后,2组患者的CRRCAE评分、CADL评分、SF-36评分均较治疗前升高（P＜0.05）,BDAE等级较前改善（P＜0.05）;治疗后观察组CRRCAE评分、CADL评分、SF-36评分均较对照组升高（P＜0.05）,BDAE等级较对照组改善（P＜0.05）。结论：tDCS刺激左背外侧前额叶结合头皮针可以更好的改善脑卒中运动性失语症的语言功能、日常交流能力及生活质量。     

低频rTMS对急性脑梗死后运动性失语的疗效观察

目的:观察低频重复经颅磁刺激(rTMS)对急性脑梗死后运动性失语的临床治疗效果。方法:将116例急性脑梗死后运动性失语患者随机分为对照组和rTMS组各58例,对照组实施常规药物治疗及语言训练,rTMS组在此基础上采用低频rTMS和语言训练同步交叉的方法来进行康复。采用西方失语症成套测验(WAB)评价失语指数(AQ)及理解、复述、命名、自发言语等成分的得分情况。采用北京医科大学第一医院的汉语失语成套测验语言功能评分百分率提高程度和语言交流障碍好转程度进行疗效评定。结果:治疗30d后,2组AQ评分及理解、复述、命名、自发言语4项评分均高于治疗前(P0.05),且rTMS组提高幅度更高于对照组(P0.05);rTMS组的总有效率明显高于对照组(P0.05)。结论:早期低频rTMS治疗对急性脑梗死后运动性失语患者具有较好的疗效。     

Recovery of cohesion in narrative discourse after left-hemisphere stroke

Little is known about the recovery of narrative discourse after stroke. While several studies have analyzed the recovery of language in individuals with aphasia, few known studies exist on the recovery of narrative discourse in stroke survivors, particularly those who have not been diagnosed with aphasia. In this study, we evaluated the cohesiveness of narrative discourse in a cohort of individuals who had suffered a left-hemisphere stroke and had not been diagnosed with expressive language impairment. We analyzed their narrative discourse at 1, 6, and 12 months poststroke. Our findings indicate that, while the mean number of cohesive ties in narrative discourse remained generally constant during the first year poststroke, the percentage correct use of cohesive ties increased significantly during the same time period. These findings suggest that subtle disruptions in expressive language can be present initially in narrative discourse, and recovery from these disruptions can occur naturally over time.     

Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method

This study examined activation levels in the left (L) supplementary motor area (SMA) and the right (R) SMA (separately), and activation in nine R perisylvian language homologues during overt, propositional speech in chronic nonfluent aphasia patients. Previous functional imaging studies with a variety of chronic aphasia patients have reported activation in these regions during different language tasks, however, overt propositional speech has not been examined. In the present research, four nonfluent aphasia patients were studied during overt elicited propositional speech at 4-9 years post-single L hemisphere stroke, which spared the SMA. The dynamic susceptibility contrast (DSC) method of functional MRI was used to calculate relative cerebral blood volume (relCBV) for cortical regions of interest (ROIs) during the first-pass bolus of gadolinium during two conditions: (1) pattern (silent viewing of checkerboard patterns) and (2) story (overt, elicited propositional speech describing sequential pictures, which formed a story). During the story condition, controls had significantly higher relCBV in L SMA than in R SMA; aphasics, however, had significantly higher relCBV in R SMA than in L SMA. During the pattern condition, no significant differences were observed between the L SMA and the R SMA for either controls or aphasics. In addition, aphasics had significantly higher relCBV in the R sensorimotor mouth during story than pattern. This R sensorimotor mouth relCBV was also significantly higher in aphasics than controls during story, and the two groups did not differ during pattern. The overall mean relCBV for the nine R perisylvian ROIs was significantly higher for aphasics than controls during both story and pattern. These results suggest that poor modulation, including possible over-activation of R sensorimotor mouth and other R perisylvian language homologues may underlie in part, the hesitant, poorly articulated, agrammatic speech associated with nonfluent aphasia.     

不同刺激靶点经颅直流电刺激对脑卒中后运动性失语症患者动词命名疗效的比较研究

目的:对比经颅直流电刺激(tDCS)刺激左侧大脑Broca区和运动区对左侧大脑额叶损伤的运动性失语症患者动词命名的疗效。方法:回顾性连续纳入2019年6月～2022年6月在首都医科大学宣武医院康复医学科住院部和门诊进行治疗的符合入组标准的失语症患者36例,将入组患者分为对照组、Broca组、M1组各12例;3组患者均接受相同时长的言语语言治疗,训练内容均为评价中的训练项图片。在此基础上,Broca组采用阳极tDCS刺激左半球Broca区,M1组为阳极tDCS刺激左半球M1区,刺激强度均1.4mA,刺激时长20min,连续治疗5d。于治疗前及治疗5d后进行动词的命名和听理解评估,其中动词命名包括训练项和非训练项动词命名。结果:治疗后,3组患者训练项动词命名成绩均较治疗前有显著提高(P<0.05),且Broca组较M1组和对照组有显著提高(P<0.05)。治疗后,Broca组非训练项动词命名成绩较治疗前有显著提高(P<0.05),且Broca组较M1组和对照组均有显著提高(P<0.05)。治疗后,Broca组动词听理解成绩较治疗前显著提高(P<0.05),且B...     

脑梗死后遗症失语患者的语言康复训练

目的:探讨脑梗死后遗症失语患者的语言康复训练措施。方法:76例脑梗死后遗症失语行语言康复训练的患者,根据其失语类型分为A、B、C三组,给予针对性的康复训练。结果:C组(命名性失语)恢复效果显著优于A组(运动性失语)和B组(感觉性失语)(P<0.05);A组略好于B组,但两组无显著性差异(P>0.05)。结论:由于发病机制及治疗效果的差异,不同类型的患者恢复效果有所不同,但系统科学的康复训练对于改善患者是有积极意义的。     

Profiling oral narrative ability in young school-aged children

This study aimed to determine if oral narrative comprehension and production measures derived in a fictional story retelling task could be used to create a profile of strengths and weaknesses in oral narrative ability (Profile of Oral Narrative Ability: PONA) in young school-aged children. The story retelling task was field-tested with 169 typically developing children, aged between 5;0 and 7;6 years. Children listened twice to an unfamiliar story while looking at the pictures in a book. Comprehension questions were asked after the first exposure. Following the second exposure, children were asked to retell the story without the use of the pictures. Story retellings were analysed on measures of semantics, morphosyntax, verbal productivity, and narrative quality. Results indicated sensitivity for age on measures of comprehension, narrative quality, semantics, and verbal productivity, but not for morphosyntactic measures. Factor analysis indicated that oral narrative performance comprised three factors, explaining more than 80% of the variance. Two clinical case examples are presented, which show the potential of the PONA to reveal different patterns of strengths and weaknesses across the oral narrative measures. Although early evidence suggests the potential usefulness of the PONA, further research is now needed to test the validity, reliability and clinical application of this tool.