脑卒中后基底节性失语的特点

目的探讨脑卒中后基底核性失语的特点。方法选择急性期单侧皮层下脑卒中后基底核性失语患者29例,行失语症检查,分析其语言学特征。结果基底节性失语有较重的听理解障碍及书写能力的受损,其中理解中度障碍18例(62%);重度障碍11例(38%);书写障碍以描写障碍突出,重度障碍25例(86%);复述相对较好,轻中度障碍24例(83%)。23例(79%)出现语音障碍,包括音韵及音律障碍。8例患者出现言语失用。基底神经节性失语多为轻至中度语言表达障碍,表现为语言减少,口语流畅性差,说话缓慢、费力,启动难,词与词之间缺乏连惯性,词汇单调,理解障碍相对较轻,可有找词困难(说不出恰当词),偶有错语,但复述正常或相对正常。结论基底节性失语在脑卒中后较为常见,其类型复杂,几乎包括所有失语类型,表现为较重的听理解障碍及书写能力的受损,书写障碍以描写障碍突出;复述相对较好;多数患者出现语音障碍,口语流畅性差;言语失用常见;命名障碍较常见。     

脑卒中失语患者早期康复训练的效果观察

目的 探讨脑卒中失语患者早期康复训练的效果.方法 对130例脑卒中失语患者按床位的单、双号随机分为观察组和对照组,采用汉语失语检查表[1]进行评定记分. 结果 2组患者出院和随访时语言表达能力均有改善(P＜0.05),但观察组改善的幅度较大. 结论 观察组的疗效优于康复组,但康复组也有一定疗效.     

经皮质感觉性失语患者的阅读障碍

近年来,关于汉语失误症的研究有了较多报道。纯失读和纯失读伴失写(指不伴口语表达及理解障碍者)虽有报道,但很少见。失读患者大多伴有失语,经皮质感觉性失语(Transcortical Sensory aphasia,TCS)属中度失语,尚有一定的口语表达及听理解能力,并有失读。为此,本文分析TCS患者失读症特点。 对象与方法 1.对象 北医大经CT证明脑梗塞8例     

苯妥英钠对脑卒中后难治性癫痫患者神经功能缺陷及记忆的影响

观察负荷量苯妥英钠对脑卒中后难治性癫痫患者记忆及神经功能缺陷的影响。选择卒中后难治性癫痫患者55例,口服苯妥英钠。根据临床疗效分为有效组26例和效差组29例两个亚组。全组治疗后第3个月患者记忆商数均有下降趋势,而后数值有波动。有效组治疗第6个月恢复至治疗前水平,第9～12个月明显超过治疗前水平,效差组呈先升后降趋势。随访期间全组患者在治疗后第4个月神经缺陷功能逐渐改善,效差组未见明显变化,有效组在治疗后第3个月明显减轻。提示苯妥英钠可以改善中风后难治性癫痫患者的病情。     

早期语言康复训练改善急性脑卒中后失语症患者的效果观察

目的观察早期语言康复训练改善急性脑卒中后失语症的效果。方法采用随机数字表法对96例确诊的急性脑卒中后失语症患者进行分组,对照组48例给予神经内科常规治疗和护理干预,治疗组48例增加语言康复训练,连续训练3个月末对比临床效果。结果治疗组语言恢复总有效率89.58%高于对照组的72.92%(P0.05);2组均可提高训练3个月末语言沟通能力,但治疗组改善幅度明显高于对照组(P0.05)。结论早期语言康复训练改善急性脑卒中后失语症患者效果确切,能够最大程度恢复语言表达能力,促进患者早日融入社会,提高生存质量,值得临床继续探讨与推广。     

语言功能康复治疗对脑卒中失语症的疗效观察

目的 探讨脑卒中失语症患者早期康复治疗的疗效及机制.方法 60例脑卒中失语症早期患者随机分为治疗组和对照组.对照组28例,单用药物治疗.治疗组32例,在药物治疗的同时予头皮针、体针和语言训练等方法进行康复治疗.治疗前后采用中国康复研究中心失语检查法对语言功能进行评价和比较.结果 2组患者在治疗前和治疗30d时,分别采用我国汉语失语症成套测验标准进行评定语言功能, 治疗前后有显著性差异(P＜0.05) .治疗组和对照组比较, 治疗组语言康复疗效较好(P＜0.05).结论 脑卒中失语症患者早期康复治疗对语言功能康复有积极意义.     

早期康复对脑卒中患者治疗的影响

目的 探讨早期康复治疗对脑血管病偏瘫患者肢体功能恢复及日常生活活动(ADL)能力的作用.方法 选择急性脑血管病偏瘫患者210例,均为首次发病,随机分为康复治疗组及对照组.康复治疗组患者在神经科常规治疗基础上给予简单常规的康复治疗,以运动疗法为主;对照组给予神经科常规治疗.每例患者在治疗前,治疗后2周、1个月及半年时分别用Fugl-Meyer运动功能(FMA)量表测试运动功能、改良Barthel指数量表(MBI)测试ADL能力和神经功能缺损评分.结果 康复治疗组患者1个月及半年时ADL运动功能恢复均明显优于对照组.结论 早期的康复治疗对脑卒中偏瘫患者运动功能和日常生活活动能力具有良好的促进作用,可提高其生活质量,减少日后并发症.     

低频重复经颅磁刺激对首次脑卒中后言语失用的疗效观察

目的 探讨低频重复经颅磁刺激(rTMS)治疗首次脑卒中后言语失用的临床疗效.方法 将南京脑科医院康复医学科住院的44例脑卒中后言语失用患者按随机数字表法随机分为对照组和rTMS组.两组患者均给予常规的言语功能康复训练,rTMS组在此基础上给予右侧Broca同源区1 Hz的rTMS治疗.于治疗前和治疗3周后选用中国康复研...     

婴儿期和儿童期创伤对成年期记忆功能的影响

目的 探讨早年不同时期的创伤对成年后记忆功能的远期影响。方法 以2014年1~12月 调查的唐山开滦集团1976年地震前后出生的在册工人共1 542人为研究对象,按照出生年月和儿童期创 伤量表（ CTQ）总分的平均分作为划界分组,共分为4组：婴儿期暴露+CTQ高分组,婴儿期暴露+CTQ低 分组,未暴露+CTQ高分组,未暴露+CTQ低分组。采用霍普金斯词汇学习测验（HVLT）和简易视觉空间 记忆测验（BVMT）分别评估3次词语记忆和空间记忆,并记录3次成绩总分。结果 （1）4组间年龄、性别、 文化程度的差异均有统计学意义（F年龄=470.094,F性别=11.911,F文化程度=43.484;P＜ 0.01）。婴儿暴露组年 龄均大于未暴露组;4组男性均多于女性,文化程度以高中为主。4组间婚姻状况、吸烟史、饮酒史、家庭 月收入的差异均无统计学意义（P＞ 0.05）。（2）在男性中,4组间HVLT1-3、HVLT总分、BVMT1-3、BVMT 总分的差异均有统计学意义（P ＜ 0.05）。除HVLT1外,婴儿期暴露+CTQ高分组的其余成绩均低于婴儿 期暴露+CTQ低分组（P ＜ 0.05）;未暴露+CTQ高分组的所有成绩均低于未暴露+CTQ低分组（P ＜ 0.05）; 婴儿期暴露+CTQ高分组仅HVLT3得分低于未暴露+CTQ高分组（P ＜ 0.05）;婴儿期暴露+CTQ低分组仅 BVMT3得分低于未暴露+CTQ低分组（P ＜ 0.05）。在女性中,4组间各项评分差异均无统计学意义（P ＞ 0.05）。（3）所有男性受试者中,初中及以下学历中,4组间仅HVLT2得分差异有统计学意义（P＜0.05）,其余 记忆功能成绩的差异均无统计学意义（P＞0.05）;高中学历中,4组间各项评分差异均有统计学意义（P＜ 0.05）; 大专及以上学历中,4组间上述记忆成绩的差异均无统计学意义（P＞ 0.05）。结论 男性婴儿期和儿童期 经历地震创伤均可能导致成年期词语和空间记忆功能受损,特别是儿童期创伤更为明显。接受高等教育 的经历可能会抵消早年创伤对记忆的远期影响。     

脑卒中鼻饲患者接受早期吞咽功能康复训练对预后的作用分析

目的分析脑卒中鼻饲患者配合早期吞咽功能康复训练对预后的改善作用。方法将我院2010-09—2013-08收治的86例神志清楚的急性脑卒中鼻饲患者随机分为常规治疗组(n=43)和康复训练组(n=43)。常规治疗组应用鼻饲等常规临床治疗,康复训练组除应用鼻饲等常规治疗外同时实施吞咽功能康复训练,1个月后比较2组患者吞咽功能、神经功能的改善情况及经口摄食量和拔出胃管情况。结果吞咽功能恢复情况,康复训练组总有效率60.5%,显著高于常规治疗组的27.9%,差异有统计学意义(P0.05)。2组患者神经功能改善情况,康复训练组总有效率69.8%,显著优于常规治疗组的46.5%,差异有统计学意义(P0.05)。同时,康复训练组平均每日经口摄食量(560.1±53.8)g,显著多于常规治疗组的(320.8±40.5)g,差异有统计学意义(P0.05)。1个月内康复训练组拔除胃管22例,显著多于常规治疗组的14例,差异有统计学意义(P0.05)。结论急性脑卒中鼻饲患者配合早期吞咽功能康复训练可显著降低吞咽困难程度、改善病情,提高生活质量,值得临床推广。     

Prevalence of anxiety in people with aphasia after stroke

Background: Anxiety is common after stroke and is associated with poorer recovery. People with aphasia after stroke are typically excluded from studies of anxiety prevalence and so the number of those affected is unclear.

Aims: To make a preliminary estimate of the prevalence of significant anxiety in people with aphasia after stroke.

Methods & Procedures: Carers to community-dwelling people with aphasia after stroke, N = 111, completed the Behavioural Outcomes of Anxiety scale (BOA), a modified Hospital Anxiety and Depression Scale – Anxiety sub-scale (HADS-A), and a modified Generalised Anxiety Disorder-7 item (GAD-7) scale to determine the presence of significant anxiety in the person for whom they cared. Associates of anxiety in people with aphasia after stroke were also investigated.

Outcomes & Results: The BOA identified 49 people (44%) as having significant anxiety. Findings for the HADS-A = 46 (41%) were similar; however, for the GAD-7, the rate was substantially lower = 18 (16%). Anxiety after stroke had a modest but significant association with younger age (all measures) and with the Frenchay Aphasia Severity Test scores (BOA and HADS-A only).

Conclusions: The prevalence of anxiety in people with aphasia after stroke is high and likely higher than in those with stroke with no aphasia when measured using a validated tool for this population. Risk factors for anxiety appear to be severity of aphasia and younger age. This finding should be tempered by the fact that this is a preliminary study in a relatively small sample consisting of those attending stroke groups and the use of caregiver assessments may overestimate the prevalence of mood disorder.     

Repetition priming of picture naming in semantic aphasia: The impact of intervening items

Background: We present an experiment that explores the nature of repetition priming of picture naming in a group of semantic stroke aphasic patients. The study was designed to extend previous investigations of repetition priming effects among other stroke aphasic patients and patients with semantic dementia. This work builds on previous work with semantic aphasic patients that shows enhanced picture-naming performance due to correct phonemic cues.

Aims: To assess the extent to which semantic control deficits observed during semantic aphasic patients' picture naming are resolved by prior exposure to an identical stimulus, and to determine the optimal lag between prime and target to maximise naming success.

Methods & Procedures: The procedure was carried out with five stroke patients who had all failed verbal and picture versions of tests of semantic association, revealing difficulties with manipulation of semantic information, and their performance was compared to five age- and education-matched controls. A total of 180 pictures to be named were presented individually on a computer screen in two sessions at least a week apart, with half preceded by an identical item in session one and the other half preceded by an identical item in session two. Three lags (0, 1, and 7 items intervening) were embedded in the pseudo-random structure such that it was unpredictable whether the next trial would be a repeat or not.

Outcomes & Results: Considerable repetition priming was observed in this semantic aphasic patient group, bringing their performance up to control level at lag 0. Priming with a very short lag between prime and target (0–1 item) significantly reduced latency. Accuracy was significantly increased and semantic errors decreased with up to seven intervening items. Controls also benefited from repetition priming, but showed little variation in latency, accuracy or errors over this range of short lags.

Conclusions: For patients with problems manipulating semantic information, repetition priming was an effective way to boost naming performance, although increasing the number of intervening items had a progressively detrimental effect. The observed repetition priming effects are interpreted within a connectionist model of speech production.     

脑卒中患者早期康复疗效的影响因素分析及干预对策

目的：探讨脑卒中患者早期康复疗效的影响因素,并提出相应的干预对策。方法选取脑卒中患者173例,将其分为恢复良好者和康复不佳者,采用FM A和M BI量表对其早期康复治疗效果进行评价。结果恢复良好的患者中年龄＜60岁、体质量指数≤25 kg/m2、家庭年收入较高、学历较高、医保付费、开始治疗较早、脑损伤面积≤3 cm2、家庭支持良好者明显多于康复较差的患者,而合并高血压、糖尿病者以及脑卒中复发患者则明显少于康复较差的患者。2组比较差异有统计学意义（P＜0·05）。2组患者性别及脑卒中类型比较差异无统计学意义（P＞0·05）。患者的年龄、家庭年收入、学历、基础疾病、是否为复发性脑卒中、病程、脑组织损伤面积以及家庭支持情况是影响早期康复治疗效果的独立危险因素。结论脑卒中患者早期康复疗效受到多重因素的影响,应根据患者的情况设计个体化的治疗和护理方案,以改善患者的预后。     

The contribution of working memory to language comprehension: differential effect of aphasia type

Background: Experimental studies of short-term memory and working memory (WM) in aphasia fail to discriminate cognitive impairments of different aphasia types—non-fluent, Broca-type aphasia and fluent, Wernicke-type aphasia. However, based on the varying fundamental features of these two aphasia syndromes, the potentially different underlying mechanisms of impairment and scant preliminary evidence of varying cognitive deficits, a differential relationship between cognitive function and language processing in these two groups can be predicted.

Aims: The current study investigates the hypothesis concerning the differential impact of cognitive impairments in individuals with fluent versus non-fluent aphasia types.

Methods & Procedures: Participants with fluent (n = 19) and non-fluent (n = 16) aphasia and participants without brain damage (n = 36) were presented with an eye-tracking WM task. Additionally, individuals with aphasia completed two language comprehension tasks.

Outcomes & Results: Results revealed significant decrease in WM capacity in individuals with aphasia compared with participants without brain damage. The two aphasia groups performed similarly on the WM and language tasks. Furthermore, for participants with non-fluent aphasia, it was revealed that WM makes a significant contribution to language comprehension, while for fluent individuals this relationship was not significant.

Conclusions: Overall, the present data support the claim that there are cognitive deficits in aphasia and that these cognitive deficits tend to exacerbate the language impairments of persons with non-fluent aphasia types. The results are discussed in the context of varying mechanisms of impairment in different types of aphasia. The present findings have important implications both for the assessment and the treatment of individuals with aphasia and for understanding the nature of aphasia.     

Prognosis of aphasia in stroke patients early after iv thrombolysis

Objective

Stroke patients with aphasia have a high long-term morbidity. Intravenous rt-PA (iv) thrombolysis is given more deliberately to these patients. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia.

Methods

Data of stroke patients treated by iv thrombolysis was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24 h. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization.

Results

Fifty patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62%) remained unchanged. Of 28 patients with EICs, 10 (36%) improved compared to 7 out of 22 (32%) patients without (p = 0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24 h (Kruskal–Wallis, p = 0.033, p ≤ 0.001, respectively).

Conclusion

EICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. One third improved within 24 h, while two thirds remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage.     

Bilingualism and memory: early 19th century ideas about the significance of polyglot aphasia

In the second half of the 19th century, there was very little attention given to bilingual speakers within the growing clinical literature on aphasia. The first major publication on this topic (Pitres, 1895), appeared three decades after Broca's seminal work. Previously, Ribot (1881) had discussed the phenomenon of bilingual aphasia in the context of diseases of memory. Although interest in the neurological basis of the language faculty was in fact present throughout the century, the theoretical implications of the knowledge of more than one language did not appear to be linked to this issue. A number of British authors writing in the first half of the 19th century have been identified who did consider the significance of these cases. Importantly, these writers speculated on the implication of bilingual aphasia specifically with regard to ideas about memory rather than language. Consideration of these writings helps to illuminate the history of ideas about the organization of language in the brain.     

Effects of different frequencies of repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia: a randomized,sham-controlled study

Objective: The purpose of this study was to compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) applied at different frequencies to the contra-lesional hemisphere to optimize the treatment of post-stroke non-fluent aphasia.

Method: Patients with post-stroke non-fluent aphasia were divided randomly into four groups: a high-frequency rTMS (HF-rTMS) group (10 Hz), a low-frequency rTMS (LF-rTMS) group (1 Hz), a sham stimulation group, and a control group. All groups received the standard treatment (consisting of drug therapy, conventional physical exercises, and speech training); in the HF-rTMS and LF-rTMS, this was supplemented with magnetic stimulation that targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed prior to, immediately after, and at 2 months post-treatment by the Chinese version of the Western Aphasia Battery (WAB).

Results: When measured immediately post-treatment, as well as at 2 months post-treatment, the LF-rTMS group exhibited a more marked improvement than the HF-rTMS group in spontaneous speech, auditory comprehension, and aphasia quotients (AQ). Compared to the control group, the HF-rTMS cohort exhibited significant improvement at 2-months post-treatment in repetition and AQ.

Conclusions: LF-rTMS and HF-rTMS are both beneficial to the recovery of linguistic function in patients with post-stroke non-fluent aphasia. LF-rTMS produced immediate benefits that persisted long-term, while HF-rTMS only produced long-term benefits. In addition, the benefits produced with LF-rTMS were more marked than those produced by HF-rTMS.     

Effects of working memory load on processing of sounds and meanings of words in aphasia

BACKGROUND: Language performance in aphasia can vary depending on several variables such as stimulus characteristics and task demands. This study focuses on the degree of verbal working memory (WM) load inherent in the language task and how this variable affects language performance by individuals with aphasia. AIMS: The first aim was to identify the effects of increased verbal WM load on the performance of judgments of semantic similarity (synonymy) and phonological similarity (rhyming). The second aim was to determine if any of the following abilities could modulate the verbal WM load effect: semantic or phonological access, semantic or phonological short-term memory (STM) and any of the following executive processing abilities: inhibition, verbal WM updating, and set shifting. METHOD AND PROCEDURES: Thirty-one individuals with aphasia and 11 controls participated in this study. They were administered a synonymy judgment task and a rhyming judgment task under high and low verbal WM load conditions that were compared to each other. In a second set of analyses, multiple regression was used to identify which factors (as noted above) modulated the verbal WM load effect. OUTCOME AND RESULTS: For participants with aphasia, increased verbal WM load significantly reduced accuracy of performance on synonymy and rhyming judgments. Better performance in the low verbal WM load conditions was evident even after correcting for chance. The synonymy task included concrete and abstract word triplets. When these were examined separately, the verbal WM load effect was significant for the abstract words, but not the concrete words. The same pattern was observed in the performance of the control participants. Additionally, the second set of analyses revealed that semantic STM and one executive function, inhibition ability, emerged as the strongest predictors of the verbal WM load effect in these judgment tasks for individuals with aphasia. CONCLUSIONS: The results of this study have important implications for diagnosis and treatment of aphasia. As the roles of verbal STM capacity, executive functions and verbal WM load in language processing are better understood, measurements of these variables can be incorporated into our diagnostic protocols. Moreover, if cognitive abilities such as STM and executive functions support language processing and their impairment adversely affects language function, treating them directly in the context of language tasks should translate into improved language function.     

Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients

Memory complaints are common after stroke, yet there have been very few studies of the outcome of memory rehabilitation in these patients. The present study evaluated the effectiveness of a new manualised, group-based memory training programme. Forty outpatients with a single-stroke history and ongoing memory complaints were enrolled. The six-week course involved education and strategy training and was evaluated using a wait-list crossover design, with three assessments conducted 12?weeks apart. Outcome measures included: tests of anterograde memory (Rey Auditory Verbal Learning Test: RAVLT; Complex Figure Test) and prospective memory (Royal Prince Alfred Prospective Memory Test); the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire and self-report of number of strategies used. Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report. Lower baseline scores predicted greater gains for several outcome measures. Patients with higher IQ or level of education showed more gains in number of strategies used. Shorter time since onset was related to gains in prospective memory, but no other stroke-related variables influenced outcome. Our study provides evidence that a relatively brief, group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome.     

The use of standardised short-term and working memory tests in aphasia research: a systematic review

Impairments of short-term and working memory (STM, WM), both verbal and non-verbal, are ubiquitous in aphasia. Increasing interest in assessing STM and WM in aphasia research and clinical practice as well as a growing evidence base of STM/WM treatments for aphasia warrant an understanding of the range of standardised STM/WM measures that have been utilised in aphasia. To date, however, no previous systematic review has focused on aphasia. Accordingly, the goals of this systematic review were: (1) to identify standardised tests of STM and WM utilised in the aphasia literature, (2) to evaluate critically the psychometric strength of these tests, and (3) to appraise critically the quality of the investigations utilising these tests. Results revealed that a very limited number of standardised tests, in the verbal and non-verbal domains, had robust psychometric properties. Standardisation samples to elicit normative data were often small, and most measures exhibited poor validity and reliability properties. Studies using these tests inconsistently documented demographic and aphasia variables essential to interpreting STM/WM test outcomes. In light of these findings, recommendations are provided to foster, in the future, consistency across aphasia studies and confidence in STM/WM tests as assessment and treatment outcome measures.