应用汉语失语症心理语言评价探查深层失读的朗读加工损害

目的:应用汉语失语症心理语言评价探查失语症深层失读的朗读加工损害及其特点,为深层失读的语言治疗提供依据。方法:采用高低频词朗读、高低表象词朗读、实词(与图命名测验内容相同的高表象词)朗读、虚词朗读、形声字家族读音一致性判断等测验,对1例脑卒中后深层失读患者进行检查。结果:患者除了在朗读时出现大量高表象语义性错语外,词频相当的低表象词朗读较高表象词朗读更困难(P<0.05),显示表象性效应;虚词朗读较实词朗读更差(P<0.001),显示词类效应。形声字家族读音一致性判断与图命名比较,形声字家族读音一致性判断更困难(P<0.05)。高频词与低频词朗读、图命名中的高频词与低频词命名比较未见显著差异。结论:该患者脑卒中后深层失读的原因是朗读时字形输入词典→语音输出词典的联结严重减退。汉语失语症心理语言评价可以探查汉语深层失读的主要特点和语言损害的加工路径,为深层失读的诊断和语言治疗及进一步的研究提供可靠的依据。     

应用汉语失语症心理语言评价探查失语症患者复述困难产生原因的研究

目的：通过汉语失语症心理语言评价,探查失语症复述困难产生的原因。方法：采用汉语失语症心理语言评价的相关检查,对1例传导性失语症患者和1例混合性失语症患者进行语言功能评价。结果：病例1的听觉、视觉词图匹配测验结果基本正常,表明该患者语义系统未受到损害。声母、韵母、声调、单字听判断以及单字声调判断均在正常范围,表明该患者听觉通路的语音识别正常。非词复述、高表象词复述、看图复述均受损,看图单字复述（14/20）比非词单字复述（2/20）和高表象词复述（8/20）好(P<0.05),提示语义对该患者的复述有影响;看图单字复述（14/20）比三字复述（2/20）好（P<0.05）,高表象词单字复述比三字复述要好（P<0.05）,显示出词长效应。非词单字与高表象单字复述比较有显著差异（P<0.001）,提示语音缓冲器内的语音表征不稳定。病例2听觉、视觉词图匹配受损,表明其语义系统受损。声母、韵母、声调听辨别均受损;非词复述中度受损,高表象词复述和看图复述轻度受损,看图复述未显示词长效应。结论：病例1传导性失语症的复述困难与语音缓冲器内的语音表征不稳定有关,病例2混合性失语症的复述困难与听觉语音识别受损有更大的关系。     

应用汉语失语症心理语言评价探查视觉性失语症伴纯失读的语言加工损害

目的:明确视觉性失语症伴纯失读患者的语言加工损害水平。方法:对1例视觉性失语症患者采用汉语失语症心理语言评价及其他相关检查进行语言评价。结果:①患者的基本视知觉、不同视点物体匹配的结构表征检查正常;②从视觉输入通达到详尽的语义受损,表现为视觉图命名障碍和视觉图—图联系困难;③将视觉词形转换为对应的语音表征受损,表现为视觉输入词朗读障碍;④将视觉词形映射到语义较听觉语音映射到语义受损更为显著,即字形输入词典到语义系统的联系受损更为严重,表现为视觉词—图匹配较听觉词—图匹配显著受损。结论:该例视觉性失语症患者的语言加工损害主要为从视觉输入(事物)通达到详尽的语义受损,以及将视觉字形通达到语义和语音表征受损。     

汉语失语症心理语言评价与汉语标准失语症检查对命名困难定性的比较

目的：探讨汉语失语症心理语言评价(PACA)与汉语标准失语症检查(ABC)哪一方法可以揭示命名困难产生的根源。方法：采用汉语失语症心理语言评价,以及汉语标准失语症检查的相关测验对2例命名困难的失语症患者进行检查。结果：例1的ABC名词听理解、名词阅读理解、图画命名完全正常,但词复述和命名言语含糊不清。PACA的名词听理解、同义词判断检查提示该患者的语义系统接近正常;语音判断、读音一致性判断及起始音分类基本正确,表明语音输出词典正常;复述检查未显示出词长效应;根据PACA确定该患者的语言损害主要定位于言语运动计划水平。例2的ABC名词听理解与阅读理解全部正确;字、词复述全部正确;命名困难。PACA的听理解、阅读理解测验表明该患者存在词汇语义损害。语音输出词典有关测验表明语音输出词典的损害比语义认知更严重。词复述和非词复述正常,提示词典后加工正常。结论：汉语失语症心理语言评价可以揭示命名产生的根源,有帮于分析和确定造成命名困难的语言加工受损水平,从而为命名困难受损的认知加工进行针对性的治疗。     

工作记忆在失语症语言理解障碍诊治中作用的研究进展

近年来,工作记忆与语言理解之间的关系受到心理学及教育学研究者越来越多的关注。本文从工作记忆的理论模型、评估方法及脑区定位等方面,综述工作记忆在临床失语症语言理解障碍诊治中的作用,并对工作记忆与理解障碍康复进程进行展望。     

非流利性失语听理解障碍与优势侧弓状纤维损伤的相关性研究

目的 采用弥散张量成像（DTI）技术探讨优势侧弓状纤维（AF）损伤与脑卒中后失语症患者听理解障碍发生的相关性。 方法 选取脑卒中后非流利性失语症患者18例设为患者组,另选取9例正常受试者设为正常组。2组受试者均进行DTI检查,测量各向异性分数值(FA),采用两样本t检验,分析比较患者组与正常组双侧AF的FA值差异;另采用汉语失语成套检测（ABC）评估患者组的言语功能,取是/否问题、听辨认、听指令作为观测指标,采用Spearman相关性分析来分析优势侧AF的FA值与ABC言语功能分项评估得分的相关性。 结果 患者组优势侧AF的FA值为0.313±0.138,显著弱于正常组的0.512±0.025,差异有统计学意义（P<0.01）。经Spearman相关性分析,患者组优势侧AF的FA值与听辨认（r=0.513,P=0.029）得分存在显著的相关性。 结论 脑卒中后失语症患者优势侧AF的损伤可能是导致听理解障碍的原因之一,主要表现为与听辨认相关。     

音乐治疗用于失语症的康复:1例报告

目的:观察音乐治疗干预对失语症患者的歌唱发音能力以及语言能力的改善作用。其中歌唱发音能力包括保持音时限、乐句完整性、音色清晰度、自发性语句、模仿性歌唱和填空式歌唱的参与、节奏的正确率。语言能力包括语言单音清晰度和发音性能。方法:患者是一位因铊中毒而引发失语症的30岁女性。使用的音乐治疗方法为治疗性歌唱法、主题语言刺激法、旋律发音治疗法。结果:在歌唱发音能力中,患者保持音时限、节奏的正确率、乐句完整性和音色清晰度这4项的变化显示与治疗次数的相关性极其显著(P<0.01)。患者自发性语句、模仿性歌唱和填空式歌唱参与的变化显示与治疗次数之间无显著性。患者语言单音清晰度中,口型、声调、声母、韵母这四项能力在治疗后有一定的改善。患者发音性能中音调过低、音量过小、发音时限过短及音调忽高忽低这4项问题在治疗后得到明显改善。嘶哑声、气息声和声音震颤3项问题没有得到改善。结论:音乐治疗对失语症患者的歌唱发音能力有明显地改善作用,而歌唱发音能力的提高能泛化到语言发音能力上,使之改善。     

无障碍电脑语言系统U1在失语症患者语言训练中的应用

目的:探讨电脑辅助语言训练系统(无障碍电脑语言系统U1)在失语症患者语言训练中的效果。方法:脑卒中、脑损伤后失语症患者23例利用无障碍电脑语言系统U1进行语言训练,对患者训练前后的语言能力进行比较。结果:失语症患者经过训练,听说读写能力有不同程度的提高,其中听理解(由36.25±21.65升至54.25±26.71)、复述(由42.00±35.58升至63.65±22.27)、读理解(由35.35±31.98升至56.42±34.11),治疗前后比较差异有非常显著性意义(t=4.9059,3.6407,3.9088,P均<0.01),其余各项治疗前后比较差异有显著性意义(t=2.4036～2.8651,P<0.05)。23例患者中20例听理解有改善,15例口语表达,18例复述、朗读、阅读有改善,12例描写、听写有改善,21例抄写有改善。结论:电脑辅助语言训练系统(无障碍电脑语言系统U1)在失语症患者康复训练中有一定治疗价值,训练效果满意。     

应用在线经颅直流电刺激探查外侧裂后部对失语症恢复的作用

目的:采用汉语失语症心理语言评价(PACA)及在线经颅直流电刺激(tDCS),探查两半球外侧裂后部周围区(PPR)是否可以促进失语症语言功能的改善,以及语言功能恢复的可能机制。方法:利用PACA对7例脑卒中后恢复期失语症患者(基底核区损伤4例,皮质损伤3例)进行语言评价,同时实施在线tDCS。在无刺激、左PPR区和右PPR区阳极刺激三种试验条件下进行失语症评价。语言评价任务为听觉词-图匹配、图命名。结结果论::阳对极恢刺复激期左失P语PR症区患时者,采图用命名tD成CS绩阳显极著刺改激善左(PP相似文献   

认知神经心理学的单字加工模型在失语症评价中的应用

目前的临床语言症状评价方法只能对 1/ 3的失语症进行分类。为了解语言障碍的原因、制定治疗计划 ,还需要借助其他的测验方法。根据认知神经心理学(ｃｏｇｎｉｔｉｖｅｎｅｕｒｏｐｓｙｃｈｏｌｏｇｙ ,ＣＮＰ)的语言处理模型 ,可以从语言处理过程中发现不同失语症的原因 ,加深对语言障碍的认识。1ＣＮＰ方法1.1研究对象　应用认知心理学和神经心理学解释失语症。前者研究正常功能状态下的智力运行 ,如物体识别、语言表达、书写、阅读、解决问题、做出决定等。后者研究知觉、感觉、情感等行为在大脑中的传递和处理过程。1.2目的　根据认知模…     

脑血管病失语症听觉理解障碍的研究

目的　听觉理解障碍是脑血管病失语症的常见症状,分析听觉理解各个过程的特点,对于汉语失语症的分类、比较东西方失语症的异同、探索语言在脑内加工过程的神经机制及言语康复具有一定意义。方法　采用汉语失语检查法和听觉理解补充检查法,并结合CT、MRI技术,对不同类型汉语失语症听觉理解障碍各个过程的特点进行比较系统的研究。结果与结论　①失语类型不同,听觉理解在各个层级受损程度也不同;②不同类型失语都存在音素辨别的损害或保留;③在词的理解上,多数失语存在程度不等的困难等级,皮质下失语无此特性,与英语失语症有一定的差别;④各种失语对被动句理解比主动句更困难;⑤各组失语中篇章理解损害均较重。     

左外侧裂后部经颅直流电刺激对失语症图命名及听理解作用的研究

目的:探查恢复期失语症患者左外侧裂后部(PPR)经颅直流电刺激(tDCS)对图命名及听理解的作用。方法:采用成组前后对照实验设计,治疗分为A、B期。A期为4周语言治疗,B期为4周tDCS治疗与语言治疗。tDCS刺激电极阳极位于左侧外侧裂后部周围区,阴极位于右肩。刺激强度1.1mA,每次20min。7例脑卒中后失语症患者在每个治疗期前后进行汉语失语症心理语言评价(PACA)。结果:7例患者经4周A期语言治疗后,图命名和听觉词—图匹配成绩未见显著改变;经4周tDCS与语言治疗后,患者的图命名和听觉词—图匹配成绩显著提高(图命名成绩平均提高64%,听觉词—图匹配成绩平均提高15%)。结论:tDCS阳极刺激左外侧裂后部周围区可以提高恢复期失语症患者的图命名和听觉词—图匹配任务的正确率,其治疗机制可能是由于阳极刺激提高了脑损伤周围区的神经元兴奋性,促进了语言功能的代偿。tDCS为失语症提供了一种新的有效的治疗技术。     

Auditory comprehension problems in aphasia from the perspective of aphasic persons and their families and friends

This study explored with a qualitative approach the experience of auditory comprehension problems from the perspective aphasic persons and their families and friends. Semi-structured group interviews were held with 55 persons (29 aphasic and 26 non-aphasic) who were asked to describe the consequences of aphasia on their lives. Most participants contributed some material to the topic of interest. They described problematic situations, and the behaviours they said they adopted at those times; they also provided explanations of what their problems were. Some discrepancies between aphasic persons and their families and friends were also noted. The essential elements of the experience of an auditory comprehension problem centre around speakers' rate of speech and situations in which aphasic persons feel they are incapable of understanding or of following because of an unfavourable environment.     

Accent on communication: the impact of regional and foreign accent on comprehension in adults with aphasia

Purpose: This study explored whether an unfamiliar non-native accent, differing in both segmental and prosodic features was more difficult for individuals with aphasia to understand than an unfamiliar native accent, which differed in segmental features only. Method: Comprehension, which was determined by accuracy judgments on true/false sentences, and speed of response were assessed in the following three conditions: a familiar Southern Standard British English (SSBE) accent, an unfamiliar native Grimsby accent, and an unfamiliar non-native Chinese accent. Thirty-four English speaking adults (17 people with and 17 people without aphasia) served as listeners for this study. Results: All listeners made significantly more errors in the unfamiliar non-native accent, although this difficulty was more marked for those with aphasia. While there was no affect of speaker accent on the response times of listeners with aphasia, listeners without aphasia were significantly slower with the unfamiliar non-native accent. Conclusion: The results indicate that non-native accented speech affects comprehension even on simple tasks in ideal listening conditions. The findings suggest that speaker accent, especially accents varying in both segmental and prosodic features, can be a barrier to successful interactions between non-native accented speakers and native listeners, particularly those with aphasia.

Implications for Rehabilitation

• Aphasia is an acquired language disorder, often occurring after stroke, which affects an individual’s understanding and use of language.

• People with and without aphasia find an unfamiliar accent more difficult to understand than a familiar accent, and these problems are more significant for those with aphasia.

• Problems are greater when the accent differs from the familiar accent by both individual sounds and prosody.

• Health professionals need to be aware that their accent is likely to affect an individual’s performance on assessments as well as their understanding of information, and could consider the use of other mediums to present information (e.g. drawing) and minimizing other variables that might compromise comprehension (e.g. background noise).

     

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment

Abstract

Purpose: This paper summarises the clinical ramification of a large-scale study of the direct and indirect (mediated) influences of four cognitive mechanisms that are relevant to the comprehension of syntactic structure by school-age children with and without developmental language disorder (DLD).

Method: A total of 117 children with DLD and 117 propensity-matched typically-developing (TD) children completed sentence comprehension tasks and cognitive tasks related to fluid reasoning, controlled attention, speed of processing, phonological short-term memory (pSTM), complex working memory (cWM) and language knowledge in long-term memory (LTM).

Result: Results of confirmatory factor analysis (CFA) indicated that the most salient characteristics of cognitive processing in children with and without DLD were represented by a measurement model that included four latent variables: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. Structural equation modelling (SEM) indicated that complex WM mediated the relationship between sentence comprehension and fluid reasoning, controlled attention and long-term memory for language knowledge.

Conclusion: Our research suggests that the most salient characteristics of cognitive processing in children with and without DLD can be condensed to four cognitive factors: fluid reasoning, controlled attention, complex WM and language knowledge in LTM. We suggest a few measures that clinicians can use to reliably assess these factors, and we summarise a functional intervention programme that is designed to promote the strategic organisation of information in ways that challenge verbal complex WM and LTM processes that support language comprehension and use.     

失语症患者的四声检查结果分析

对16例失语症患者进行汉语四声的听理解与朗读检查评价,其中12例非流畅性失语,4例流畅性失语。应用统计学分析表明,四声朗读与四声听理解等结果比较差异显著(P<0.001)。此次研究表明,应用汉语普通话的失语症患者的四声检查与失语症其它分项检查同样具有重要意义。