脑卒中后基底核性失语特征及针对性语言训练的效应

目的:分析脑卒中后基底核性失语的发生情况、语言障碍的特点并观察对其进行针对性语言治疗的疗效。方法:选择急性期单侧皮层下脑卒中后基底核性失语症患者29例,行失语症检查,分析其神经语言学特征。并将病程1个月患者入选进行早期语言康复训练,于治疗1个月后再次进行失语症评测,对训练前后的语言能力进行比较。结果:基底核性失语症患者病灶多位于左侧基底核。基底核性失语症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,重度障碍11例;书写障碍以描写障碍突出,重度障碍25例;复述相对较好,轻中度障碍24例。患者语音障碍23例,包括音韵及音律障碍。8例患者出现言语失用。经过早期针对性语言治疗,患者在听理解,口语表达、朗读、阅读、描写、听写等方面,治疗前后其正答率比较差异有显著性意义(P<0.05),语音障碍也有改善。结论:脑卒中后基底核性失语其有特定的神经语言学特点。进行早期语言训练疗效较好。     

脑卒中后基底节性失语症的特征

目的:脑卒中后基底节性失语症为临床常见疾病,但是否皮由质下结构导致了这些失语仍存在争论。基底节性失语症有特定的神经语言学特征,选择针对性语言康复治疗是有效的。资料来源:应用计算机检索中国期刊全文数据库1988-01/2005-12与脑卒中、皮质下及基底节性失语及语言康复相关的文献,检索词为“脑卒中、基底节性失语、语言康复”,限定语言种类为中文,同时检索Medline1982-01/2005-12的关于失语症的文献,检索词包括basalganglia,Subcorticalaphasia,apraxiaofspeech等,并限定文章语言种类为English。并手工查阅与之内容相关的书籍若干。资料选择:对资料进行初审,选择与脑卒中后基底节性失语症的病理机制,神经语言学特征,失语症诊断方法,语言康复方法相关的文章,然后筛除与以上要求无明显联系的文章。纳入标准:详细阐述基底节失语症的临床特征、神经语言学发病机制、康复治疗方法相关文献。排除标准:重复性研究。资料提炼:共收集到95篇关于基底节失语症的文献,涉及基底节失语症临床特征文献31篇,其中神经语言学发病机制篇45篇,失语症评估及分类5篇,康复治疗方法14篇。排除65篇选择符合标准的30篇用于综述。资料综合:对脑卒中后基底节性失语的定义,研究现状进行简明介绍,在此基础上详述基底节性失语复杂的神经语言学特征,从临床失语症状组合出发,进行失语症评估,探讨失语症状与病灶部位的关系,了解脑卒中后基底节性失语症患者的病态语言行为发生机制,为验证语言在脑内加工过程的神经机制提供重要资料;另一方面阐述脑卒中后基底节性失语症患者语言康复治疗方法。结论:脑卒中后基底节性失语为临床常见疾病,有其特定的神经语言学特征,基底节结构参与语言形成过程,其机制有待进一步证实。选择针对性语言康复治疗是有效的。神经语言学家和临床医生正努力探索基底节结构在语言及言语形成过程中的整和作用。     

说汉语的失语患者言语表达的初步分析

目的：研究说汉语的失语患者在文法上的特点。方法：收集脑血管意外失语患者22例，右侧病变8例，左侧14例。进行失语评定后，根据13项文法指标，研究其失文法特点，并与14例正常人加以对比。结果：前部失语患者均表现为不能正确地组合语句，口语障碍为语句不完整，少长句及复杂句；后部失语患者能说出连串的长句和复杂句，但存在较多的错语和新语。文字表达的检查中，前部失语的患者容易颠倒主-谓和谓-宾关系；后部失语患者则容易颠倒主-宾关系，即混淆实质词的语义层的句法功能。结论：汉语失语患者对词的语义保留比对音位保留程度相对好；声调性错语与声韵错语(即音位错语)一起出现。左颢顶部受损导致语义层理解障碍，脑深部病变引起的句法结构障碍依其受损部位和范围而异。     

中重度皮层下失语的语言特征及训练疗效分析

目的筛查影响皮层下失语严重程度的因素,分析中重度皮层下失语患者语言障碍的特点及语言训练的疗效.方法选择皮层下失语症患者22例,其中中度10例,重度12例,于语言训练前后,分别采用汉语标准失语症检查法(CRRCAE)、波士顿失语症检查(BDAE)进行评估,筛查失语症严重程度的影响因素,分析语言障碍的特点及神经语言学特征,比较治疗前后各项语言能力差异.结果年龄、有无并发言语失用两个因素进入失语症严重程度的回归方程.皮层下失语症患者听理解、阅读理解、复述及出声读等语言能力相对保留.语言训练后,中度皮层下失语患者各项语言能力明显改善,重度皮层下失语患者听理解、复述、说、出声读、阅读等语言能力明显改善,书写能力改善不明显.结论年龄、是否并发言语失用可能是影响皮层下失语严重程度的重要因素.脑卒中后皮层下失语有特定的神经语言学特点,语言训练疗效显著,中重度皮层下失语患者语言训练疗效有差异.     

脑卒中后基底节性失语症的特征

目的：脑卒中后基底节性失语症为临床常见疾病,但是否皮由质下结构导致了这些失语仍存在争论.基底节性失语症有特定的神经语言学特征,选择针对性语言康复治疗是有效的.资料来源：应用计算机检索中国期刊全文数据库1988-01/2005-12与脑卒中、皮质下及基底节性失语及语言康复相关的文献,检索词为“脑卒中、基底节性失语、语言康复”,限定语言种类为中文,同时检索Medline 1982-01/2005-12的关于失语症的文献,检索词包括basalganglia,Subcortical aphasia,apraxia of speech等,并限定文章语言种类为English.并手工查阅与之内容相关的书籍若干.资料选择：对资料进行初审,选择与脑卒中后基底节性失语症的病理机制,神经语言学特征,失语症诊断方法,语言康复方法相关的文章,然后筛除与以上要求无明显联系的文章.纳入标准：详细阐述基底节失语症的临床特征、神经语言学发病机制、康复治疗方法相关文献.排除标准：重复性研究.资料提炼：共收集到95篇关于基底节失语症的文献,涉及基底节失语症临床特征文献31篇,其中神经语言学发病机制篇45篇,失语症评估及分类5篇,康复治疗方法14篇.排除65篇选择符合标准的30篇用于综述.资料综合：对脑卒中后基底节性失语的定义,研究现状进行简明介绍,在此基础上详述基底节性失语复杂的神经语言学特征,从临床失语症状组合出发,进行失语症评估,探讨失语症状与病灶部位的关系,了解脑卒中后基底节性失语症患者的病态语言行为发生机制,为验证语言在脑内加工过程的神经机制提供重要资料;另一方面阐述脑卒中后基底节性失语症患者语言康复治疗方法.结论：脑卒中后基底节性失语为临床常见疾病,有其特定的神经语言学特征,基底节结构参与语言形成过程,其机制有待进一步证实.选择针对性语言康复治疗是有效的.神经语言学家和临床医生正努力探索基底节结构在语言及言语形成过程中的整和作用.     

脑卒中后汉语语法缺失与脑损害区域的关系

背景约1/3的脑损害患者存在不同程度的语言功能受损或丧失,其中大部分存在不同程度的语法缺失.目前,关于汉语语法加工究竟由左半球或右半球还是两半球共同参与完成的尚不清楚.目的探讨脑卒中后汉语语法缺失与脑损害区域的关系,为脑卒中后汉语语法缺失患者的语言康复提供理论依据.设计病例-对照分析.对象收集2001-10/2002-08武汉大学附属人民医院住院的脑卒中患者60例,所有患者均首次发病,经颅脑CT检查证实为左或右半球单发病灶.根据病灶所在侧分为左半球脑卒中组和右半球脑卒中组各30例.正常对照组为30名既往无脑器质性疾病史和神经系统症状、体征的健康志愿者.方法先用标准汉语失语检查法检查语言,初步确定有无语法障碍;然后应用汉语语法量表(包括词类、语序、语用、句子-图画匹配、语言符号操作等)对3组被试者进行测试,利用统计学结果分析汉语语法缺失与CT所示脑损害区域的关系及意义.应用计算机图像处理技术对20例汉语语法缺失患者的颅脑CT图像进行标准化处理,观察病变的集中趋势.主要观察指标①汉语语法量表评估结果.②CT图像标准化处理结果.结果按意向处理分析,90名被试者全部进入结果分析.①汉语语法量表评估结果左半球脑卒中组患者的词类、语序、语用、句图匹配和语言符号操作评分显著低于右半球卒中组和正常对照组(P＜0.01),右半球脑卒中组仅句-图匹配项低于正常对照组(79.73±13.67,1.76±7.78,P＜0.01),其他项目差异无显著性意义(P＞0.05).②CT图像标准化处理后,病变部位主要集中在左额叶和左颞叶.结论左额-颞叶神经网络系统损伤与汉语语法缺失密切相关,右额-颞叶神经网络系统参与句法辅助加工,完整的汉语语法认知需要大脑两半球的协同活动.     

皮层性失语的神经语言学特点及发病机制研究

目的：研究汉语皮层性失语的神经语言学特点及发病机制，方法：采用ABC法及补充语法检查对67例脑血管病致皮层单灶性损害患者进行神经语言学检查，并行头颅CT图像标准化及脑电地形图检查。结果：运动性失语（BA）病损范围大于Broca区，经皮层运动性失语（TCMA）少数也有Broca区部分受损，感觉性失语病灶范围差异较大，经皮层混合性失语（TMA）病灶介于TCMA及经皮层感觉性失语（TCSA）之间，BA及TCMA均有音位及声调障碍，功能词完成差，实质词正常，主动句正常，被动句理解障碍；感觉性失语（WA）及TCSA音位声调正常，功能词正常,实质词完成极差，尤以同义词较多的名词提取障碍，主动句及被动句理解均障碍，结论：各型失语病灶有其结构及功能定位，可指导临床医生进行定位诊断，各型失语神经语言学特点不同，应作为针对性制安康复计划的客观依据。     

脑卒中后基底核性失语特征及针对性语言训练的效应

目的：分析脑卒中后基底核性失语的发生情况、语言障碍的特点并观察对其进行针对性语言治疗的疗效。方法：选择急性期单侧皮层下脑卒中后基底核性失语症患者29例，行失语症检查，分析其神经语言学特征。并将病程1个月患者入选进行早期语言康复训练，于治疗1个月后再次进行失语症评测，对训练前后的语言能力进行比较。结果：基底核性失语症患者病灶多位于左侧基底核。基底核性失语症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，重度障碍11例；书写障碍以描写障碍突出，重度障碍25例；复述相对较好，轻中度障碍24例。患者语音障碍23例，包括音韵及音律障碍。8例患者出现言语失用。经过早期针对性语言治疗，患者在听理解，口语表达、朗读、阅读、描写、听写等方面，治疗前后其正答率比较差异有显著性意义(P&;lt;0．05)，语音障碍也有改善。结论：脑卒中后基底核性失语其有特定的神经语言学特点。进行早期语言训练疗效较好。     

汉语失语症心理语言评价在探查听理解障碍的语言加工受损水平中的应用:1例报告

目的:应用汉语失语症心理语言评价(PACA)是否可以明确脑卒中后听理解障碍产生于听觉言语输入加工的某个水平,通过复测是否可预测听理解能力恢复的可能。方法:对1例听理解严重损害伴杂乱语,左颞顶叶、右颞叶脑梗死患者发病后2周和5周分别进行汉语失语症心理语言评价相关检查。结果:患者发病2周后的听觉词-图匹配正确率17.5%,视觉词-图匹配正确率90.0%,看图-书写正确率67.5%,看图命名正确率47.5%,词复述2.5%。听理解与阅读理解测验结果存在明显差异(P0.01),提示语义保留较好,而听觉语音映射到语义表征之前的加工受损。因此对听觉输入的语音分析进行了进一步检查,包括环境声音识别、语音识别、最小差异听字-指图均受损,语音识别、最小差异听字-指图受损更为严重。诊断感觉性失语症。第2次语言评价结果显示:视觉词-图匹配完全恢复正常,看图书写改善,听觉词-图匹配略有改善,词复述、环境声音识别、语音识别、最小差异听字指图未见改变。结果提示语音听感知受损,导致后续的听觉词汇加工不能进行,而语义系统正常。复测结果显示语音加工无改变,提示听理解预后较差,而影响听理解恢复的是语音识别。结论:汉语失语症心理语言评价可以较好地揭示听理解损害的加工水平,通过复测可提供语言功能预后,并使失语症的语言治疗更有针对性。     

脑卒中后失语事件相关电位N400语言任务范式探讨

正脑卒中后失语是一种由于大脑局部病变、神经受损导致患者后天语言习得能力受损或丧失的一种获得性语言综合障碍,脑卒中后失语患者的住院时间延长,费用负担大,失去了对事物正常理解、交流等人类日常生活的必备技能,极大地影响了患病人群的生存质量。现今对脑卒中后失语的研究涉及神经病学、神经生理学、神经病理学、神经影像学、神经心理学、神经语言学、神经信息学、认知科学等多项科学领     

Dissociation in the neural basis underlying Chinese tone and vowel production

Neuropsychologists have debated over whether the processing of segmental and suprasegmental units involves different neural mechanisms. Focusing on the production of Chinese lexical tones (suprasegmental units) and vowels (segmental units), this study used the adaptation paradigm to investigate a possible neural dissociation for tone and vowel production. Ten native Chinese speakers were asked to name Chinese characters and pinyin (Romanized phonetic system for Chinese language) that varied in terms of tones and vowels. fMRI results showed significant differences in the right inferior frontal gyrus between tone and vowel production (more activation for tones than for vowels). Brain asymmetry analysis further showed that tone production was less left-lateralized than vowel production, although both showed left-hemisphere dominance.     

Semantic Priming in Aphasia as a Function of Prime-Target Association

Recent research has demonstrated preserved semantic priming in aphasia and proposed, therefore, that the structure of the semantic lexicon is likely to be intact in aphasic subjects. The present study used a lexical decision task to investigate semantic priming in aphasia as a function of different categories of prime-target relationship (e.g., superordinate, contrast coordinate, function associate etc.). The aphasic subjects (n=10) demonstrated a qualitatively similar pattern of semantic priming to matched controls (n=10), however this priming effect did not reach statistical significance in either the aphasic or control groups. The results are discussed in relation to the role of inhibition priming and the influence of postaccess lexical decision processes associated with controlled priming.     

Voice recognition and aphasia: can computers understand aphasic speech?

Purpose : This preliminary investigation of the use of voice recognition software by people with aphasia presents a new method of training the software, which allows the aphasic user to by-pass the linguistically demanding standard training. It examines how accurately voice recognition software performed with aphasic speech and language as compared to that of control subjects. Method : Five non-impaired controls and six participants with aphasia used a vocabulary of 50 words and 24 phrases to train the software over a maximum of five sessions. For the people with aphasia baseline assessments provided a profile of speech and language impairment. Measures of software accuracy were taken for all subjects at baseline and after four subsequent training sessions, for both single word and phrase level dictation. Results : Word level production resulted in similar accuracy levels for both groups. Phrase level production showed greater accuracy levels than single word level production for both aphasics and controls, but participants with greater speech difficulties had lower software accuracy scores. Conclusions : Training the software on a specific vocabulary allows people to access it whose speech and language difficulties would otherwise have prevented them. Findings are discussed in relation to use of the software as a dictation tool and as an input device to therapy software.     

A computerised communication aid for people with aphasia

PURPOSE: To develop a portable computerised communication aid for aphasic people to support communication in everyday life. METHOD: A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. RESULTS: Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. CONCLUSIONS: Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.     

Voice recognition and aphasia: can computers understand aphasic speech?

Purpose : This preliminary investigation of the use of voice recognition software by people with aphasia presents a new method of training the software, which allows the aphasic user to by-pass the linguistically demanding standard training. It examines how accurately voice recognition software performed with aphasic speech and language as compared to that of control subjects.

Method : Five non-impaired controls and six participants with aphasia used a vocabulary of 50 words and 24 phrases to train the software over a maximum of five sessions. For the people with aphasia baseline assessments provided a profile of speech and language impairment. Measures of software accuracy were taken for all subjects at baseline and after four subsequent training sessions, for both single word and phrase level dictation.

Results : Word level production resulted in similar accuracy levels for both groups. Phrase level production showed greater accuracy levels than single word level production for both aphasics and controls, but participants with greater speech difficulties had lower software accuracy scores.

Conclusions : Training the software on a specific vocabulary allows people to access it whose speech and language difficulties would otherwise have prevented them. Findings are discussed in relation to use of the software as a dictation tool and as an input device to therapy software.     

Word processing at 19 months and its relation to language performance at 30 months: A retrospective analysis of data from German learning children

Recent research has shown that the early lexical representations children establish in their second year of life already seem to be phonologically detailed enough to allow differentiation from very similar forms. In contrast to these findings children with specific language impairment show problems in discriminating phonologically similar word forms up to school age. In our study we investigated the question whether there would be differences in the processing of phonological details in normally developing and in children with low language performance in the second year of life. This was done by a retrospective study in which in the processing of phonological details was tested by a preferential looking experiment when the children were 19 months old. At the age of 30 months children were tested with a standardized German test of language comprehension and production (SETK2). The preferential looking data at 19 months revealed an opposite reaction pattern for the two groups: while the children scoring normally in the SETK2 increase their fixations of a pictured object only when it was named with the correct word, children with later low language performance did so only when presented with a phonologically slightly deviant mispronunciation. We suggest that this pattern does not point to a specific deficit in processing phonological information in these children but might be related to an instability of early phonological representations, and/or a generalized problem of information processing as compared to typically developing children.     

Brain activation and lexical learning: The impact of learning phase and word type

This study investigated the neural correlates of second-language lexical acquisition in terms of learning phase and word type. Ten French-speaking participants learned 80 Spanish words–40 cognates, 40 non-cognates–by means of a computer program. The learning process included the early learning phase, which comprised 5 days, and the consolidation phase, which lasted 2 weeks. After each phase, participants performed an overt naming task during an er-fMRI scan. Naming accuracy was better for cognates during the early learning phase only. However, cognates were named faster than non-cognates during both phases. The early learning phase was characterized by activations in the left iFG and Broca's area, which were associated with effortful lexical retrieval and phonological processing, respectively. Further, the activation in the left ACC and DLPFC suggested that monitoring may be involved during the early phases of lexical learning. During the consolidation phase, the activation in the left premotor cortex, the right supramarginal gyrus and the cerebellum indicated that articulatory planning may contribute to the consolidation of second-language phonetic representations. No dissociation between word type and learning phase could be supported. However, a Fisher r-to-z test showed that successful cognate retrieval was associated with activations in Broca's area, which could reflect the adaptation of known L1 phonological sequences. Moreover, successful retrieval of non-cognates was associated with activity in the anterior-medial left fusiform and right posterior cingulate cortices, suggesting that their successful retrieval may rely upon the access to semantic and lexical information, and even on the greater likelihood of errors.     

Language-invariant verb processing regions in Spanish-English bilinguals

Nouns and verbs are fundamental grammatical building blocks of all languages. Studies of brain-damaged patients and healthy individuals have demonstrated that verb processing can be dissociated from noun processing at a neuroanatomical level. In cases where bilingual patients have a noun or verb deficit, the deficit has been observed in both languages. This suggests that the noun-verb distinction may be based on neural components that are common across languages. Here we investigated the cortical organization of grammatical categories in healthy, early Spanish-English bilinguals using functional magnetic resonance imaging (fMRI) in a morphophonological alternation task. Four regions showed greater activity for verbs than for nouns in both languages: left posterior middle temporal gyrus (LMTG), left middle frontal gyrus (LMFG), pre-supplementary motor area (pre-SMA), and right middle occipital gyrus (RMOG); no regions showed greater activation for nouns. Multi-voxel pattern analysis within verb-specific regions showed indistinguishable activity patterns for English and Spanish, indicating language-invariant bilingual processing. In LMTG and LMFG, patterns were more similar within than across grammatical category, both within and across languages, indicating language-invariant grammatical class information. These results suggest that the neural substrates underlying verb-specific processing are largely independent of language in bilinguals, both at the macroscopic neuroanatomical level and at the level of voxel activity patterns.     

功能性语言沟通能力检查法及其在检测中风失语症中的应用——Ⅱ.与改良波士顿诊断性失语症评测法的比较

中国式功能性语言沟通能力检查法(CFCP)和改良波士顿诊断性失语症评测法(BDAE)同时应用于20名中风后失语患者的检测。结果显示,CFCP和BDAE均能反映失语患者残存的语言能力,CFCP能更好地评估失语患者日常生活功能沟通的变化和指导语言康复训练,而相对简便易行。