运动性失语患者的句法理解障碍

目的讨论运动性失语患者的句法理解障碍的机制。方法采用标准汉语失语检查法和句法理解的补充检查,对10例运动性失语患者进行测验。结果对复杂是否句的理解比简单是否句理解困难,对可逆被动句和“把”字结构句的理解较主动句理解困难,对功能词的理解较实义词的理解困难。结论运动性失语患者的句法理解障碍与功能词的异常加工有关。     

中西医治疗脑卒中失语述评

脑卒中失语的临床表现繁多，机理复杂，故至今仍有许多难以解决的问题。对失语症的研究，中西医各有侧重，中医侧重治疗，西医侧重机理探讨、各种失语症的分类、评价及有针对性的康复训练等；现代失语症的研究涉及神经语言学、神经心理学、认知科学、神经康复、神经电生理和神经影像等多种方法，而且往往涉及到多学科交叉，并已成为认识脑机能的有力工具。     

Telerehabilitation of anomia in primary progressive aphasia

Background: The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness.

Aims: The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA).

Methods & Procedures: Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of 6 months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA.

Outcomes & Results: All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items under both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items under the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected.

Conclusions: Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.     

Candidacy for conversation partner training in aphasia: findings from a Dutch implementation study

Background: Aphasia rehabilitation should comprise a family-centred approach, involving main conversation partners in the rehabilitation process as soon as possible. A standardised approach to conversation partner training (CPT) became available in the Netherlands with the release of Partners of Aphasic clients Conversation Training (PACT). PACT was introduced in clinical practice in a multi-centre implementation study with 34 participating dyads.

Aims: To explore candidacy for CPT by describing the characteristics of dyads where the conversation partner engaged in CPT and to identify which characteristics had the potential to predict benefit of PACT.

Methods and Procedures: A pre-post treatment design was used in a multi-centre study. Pre- and post-CPT measures of psychosocial characteristics (caregiver burden, depression and coping) from the partner and behavioural characteristics (cognitive, linguistic and communicative) from the person with aphasia (PWA) were collected. Partner experience was assessed using four scales from the Intrinsic Motivation Inventory. Pre-post measures were analysed using paired T-tests and Wilcoxon signed ranks tests. Multiple regression analyses were used to assess potential predictors of training outcomes.

Outcomes and Results: Partners of people with moderate to severe aphasia engaged in PACT when it was first introduced in clinical practice (N = 34 dyads). Mean time post-onset was 11.5 months. Partners enjoyed the practical training in which they actively engaged through experiential learning methods. Partner scores increased significantly over the intervention time on task-oriented and avoidance-oriented coping skills and their symptoms of depression lowered significantly. Caregiver esteem was found to be a positive predictor of feelings of competence and enjoyment with the training. Older partners enjoyed the training less. More effort was given to the training by the partner when the aphasia was more severe.

Conclusions: This study found that partners are willing to engage in CPT once the PWA returned home and the dyads were engaging in more everyday conversations in their home environment. The results underline the importance of partner characteristics, such as motivation, coping style and a positive outlook on caregiving as possible selection criteria for CPT.     

The role of intensity in constraint-induced language therapy for people with chronic aphasia

Background: Studies of intensive aphasia treatments vary widely in terms of treatment focus, in patient population and, in particular, in definition of what is considered “intensive”. Variability makes it difficult to compare among studies and to definitively determine whether more treatment is actually better. Constraint-induced language therapy (CILT) is one treatment that has been successfully replicated at approximately the same dosage with generally positive results.

Aims: The current study used a modified multiple baseline design across participants to investigate the administration of CILT at the standard intensive dosage of 30 hours over 2 weeks (CILT-I) compared to a more distributed dosage of 30 hours over 10 weeks (CILT-D).

Methods & Procedures: Eight participants with chronic aphasia participated in either CILT-I or CILT-D. Standardised and discourse measures were taken pre- and post-treatment and also 4 weeks after the completion of treatment. Discourse probes were administered after every 6 hours of treatment to assess change in productivity and efficiency over time.

Outcomes & Results: All of the participants who received CILT-I and CILT-D showed either an increased effect size on a discourse measure, a clinically significant change on a standardised battery or both. Gains were maintained in nearly all cases.

Conclusions: CILT administered in both intensive and distributed dosages resulted in positive changes in aphasia severity and discourse. This study adds evidence to the still inconclusive role of intensity to CILT.     

Reliability and validity of the Korean version of the Communicative Activity Log (CAL)

Background: The ultimate goal of aphasia rehabilitation is to enhance communicative activities in people with aphasia (PWA) in order to increase their daily activities and social participation. The amount of communication and its quality largely vary according to language and cultural differences.

Aims: This study was designed to develop a Korean version of the Communicative Activity Log (CAL), and to verify its reliability and validity for PWA after stroke.

Methods & Procedures: A Korean version of the CAL (K-CAL) was developed through a cross-cultural adaptation process consisting of the following six steps: translation, reconciliation, back-translation, cognitive debriefing, feedback, and final reconciliation. Internal consistency, test–retest reliability, concurrent validity, and construct validity were used to verify its reliability and validity for PWA after stroke. A total of 50 PWA completed the K-CAL with the help of caregivers. All participants completed the K-CAL again 1 week later to measure test–retest reliability. Communication score on the Korean version of Stroke and Aphasia Quality of Life Scale-39 (K-SAQOL-39) was used to demonstrate concurrent validity. Severity of aphasia assessed by Korean version of the Frenchay Aphasia Screening Test (K-FAST) was used to determine construct validity of the K-CAL.

Outcomes & Results: Among the 50 PWA, 20 had cerebral infarction and 30 had brain haemorrhage. Mean duration after onset of aphasia was 47.96 ± 62.01 months. Mean communication scores on the K-SAQOL-39 and K-FAST were 2.63 ± 0.97 and 12.69 ± 9.78 points, respectively. K-CAL demonstrated high internal consistency (Cronbach’s α = .987) and test–retest reliability (r = .915, p < .001). Correlation between K-CAL and communication score on the K-SAQOL-39 revealed a high concurrent validity (r = .915, p < .001). Correlation between K-CAL and K-FAST also showed a high construct validity (r = .882, p < .001).

Conclusions: A K-CAL was successfully developed through a cross-cultural adaptation process. Our results suggested that K-CAL had high reliability and validity for assessing communicative behaviour of Korean PWA after stroke.