基于普通话失语库的命名性失语和健康人对照话语特征探析

目的：以普通话失语库的健康成人语料为对照,分析命名性失语症患者在3种话语任务中的话语特征。方法：选取命名性失语症患者和健康成人分别为失语组和对照组各12例,2组受试者均进行简易精神状态（MMSE）和西方失语症成套测试（WAB）评估,收集单图描述、组图叙事和命题故事3种任务中的多媒体语料,应用计算机语言分析软件(CLAN)分析总句数、单词型话语均长（WMUL）、形次比移动均值（MATTR）、语速和命题密度5项参数,并对词性分布进行统计分析。结果：失语组MMSE评分和AQ明显低于对照组（P＜0.05）;方差分析显示组别和任务无交互作用,组别主效应中失语组WMUL、MATTR、语速、命题密度4个话语参数均显著低于对照组（均P＜0.05）;任务主效应中,命题故事中的总句数和命题密度产出均高于单图描述和组图叙事(均P＜0.05),且语速高于单图描述(P＜0.05);t检验显示单图描述中失语组在WMLU、MATTR、语速和命题密度上均显著低于对照组(均P＜0.05),组图叙事中失语组在总句数、MATTR和语速上显著低于对照组(均P＜0.05),命题故事中失语组在WMLU、MATTR和语速上显著低于对照组(均P＜0.05);各任务的词类在2组间有不同的分布模式,失语组在组图叙事的名词、动词和副词产出都显著偏少,其单图描述的名词、代词和介词产出显著偏多,其命题故事的代词产出显著偏多而介词相反。结论：命名性失语的语速和词汇多样性在各任务中均低于对照组。基于健康成人对照可分析命名性失语者在不同任务中的词类分布特征,在汉语失语库基础上进行话语分析,可以为失语症评估和治疗提供新视角。     

皮质下失语患者的口语表达障碍: 18例分析

目的 分析皮质下失语患者在口语表达中音位障碍和词汇障碍特点以及可能的病理机制,为言语康复训练提供依据. 方法 用汉语失语检查法( ABC法)对武汉大学人民医院神经内科收治的 18例左侧皮质下血管病变引起的丘脑性失语和基底核性失语患者进行检查.分析两类失语患者在复述中音位错误和视命名中词汇错误出现的次数,并进行比较. 结果 皮质下失语的音位错误中音素替代最多(各自出现 27次 /84.4%, 10次 /66.7%),环境错误最少各自 2次.在词汇错误中丘脑性失语最多的类型是语义上位关系词替代( 32次 /42.5%),基底核性失语是音位错语( 11次 /26.8%),丘脑性失语与基底核性失语相比差异有显著性意义(χ 2=18.828,P< 0.05). 结论 皮质下失语患者在口语表达中的不同特点,揭示皮质下结构参与了语音、词汇-语义的组织表达.     

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。     

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...     

皮质下失语患者的口语表达障碍：18例分析

目的：分析皮质下失语患者在口语表达中音位障碍和词汇障碍特点以及可能的病理机制，为言语康复训练提供依据。方法：用汉语失语检查法(ABG法)对武汉大学人民医院神经内科收治的18例左侧皮质下血管病变引起的丘脑性失语和基底核性失语患者进行检查。分析两类失语患者在复述中音位错误和视命名中词汇错误出现的次数，并进行比较。结果：皮质下失语的音位错误中音素替代最多(各自出现27次／84．4％，10次／66．7％)，环境错误最少各自2次。在词汇错误中丘脑性失语最多的类型是语义上位关系词替代(32次／42．5％)，基底核性失语是音位错语(11次／26．8％)，丘脑性失语与基底核性失语相比差异有显著性意义(r=18．828，P&;lt;0．05)。结论：皮质下失语患者在口语表达中的不同特点，揭示皮质下结构参与了语音、词汇-语义的组织表达。     

髋关节旋转活动度(ROM)的分型:健康人与下背痛病人的比较

<正> 本文的研究目的是:1)研究健康人和下背痛病人的髋旋转活动度的大小;2)根据髋旋转活动度的不同类型对上述两类人进行分类;3)比较健康人和下背痛病人在各活动度类型中的分布情况。方法:健康人组共100例(男25,女75,年龄21～41岁),病人组由50名下背痛的病人所组成(男21,女29例,年龄23～61岁)。资料分析:作者将所有健康人和下背功能障碍病人的髋旋转活动度分为3个类型,根据预先进行的可靠性研究结果,作者规定测量中两者差异在10度以内属于活动范围均等,差异大于10度属于活动范围不均等。作     

汉语后部失语患者语言障碍个案研究

目的:对病灶局限的汉语后部失语患者的语言受损和语言保留情况进行个案分析,验证语言处理的双机制假说,并为临床语言治疗提供相关神经语言学依据。方法:选取1例病灶局限的枕、顶、颞叶受损的后部失语患者,通过自然交谈和西部失语症量表检查(WAB)检测收集语料,并辅以图片命名及句子复述等任务,全面检测和分析汉语后部失语患者的语言障碍,重点关注其句法-词汇分离,以及与之相关的名—动分离现象。结果:颞叶受损患者词汇受损严重,句法保留相对较好;词汇理解较好,但是产出困难;词汇产出存在名动分离现象,呈现出名词特异性损伤的特点。结论:汉语后部失语患者句法保留较好、词汇受损严重,以及相关的名动分离的事实,一方面为语言处理的词汇—规则双机制假说提供有力证据,另一方面为汉语后部失语患者的语言有效康复方面提供神经语言学依据。     

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。     

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。     

Relationship脑梗死后失语症类型与病变部位的关系(英文)

背景:病变部位对失语症的发生及失语症的类型起着决定性的作用,但却不能很好地解释临床上的某些现象,失语症类型与病变部位之间有何关系?目的:探讨病变部位对失语症类型的作用,并分析两者之间的关系。设计:病例观察。单位:牡丹江医学院附属红旗医院神经内科。对象:纳入牡丹江医学院附属红旗医院神经内科2003-08/2004-06住院的急性脑梗死后失语症患者98例。男63例,女35例;平均年龄(68±4.56)岁;病程2～4周。方法:应用北京医科大学第一医院神经内科的汉语失语成套测验中的利手评定进行利手判定,西部失语成套测验进行失语症的分类,波士顿诊断性失语严重程度分级标准进行失语症严重程度分级及CT和MRI检查。主要观察指标:脑梗死患者失语症的类型和病变部位。结果:按实际处理分析,98例均进入结果分析。①利手判定:98例失语症患者均为右利手。②失语症的类型:Broca失语21例,Wernicke失语15例,传导性失语2例;经皮质运动性失语8例,经皮质感觉性失语7例,经皮质混合性失语12例,完全性失语23例,命名性失语10例。③病变部位:位于经典的语言中枢的有56例,38例为非语言中枢受累;波士顿诊断性失语严重程度分级标准评定结果为0级28例,1级30例,2级14例,3级16例,4级10例,其中0级、1级病变部位多为语言中枢。结论:失语症的类型与经典的语言中枢并不完全相符,非语言中枢病变也可引起失语,病变部位位于语言中枢的失语严重程度较大。     

Category-specific activations during word generation reflect experiential sensorimotor modalities

According to the sensorimotor theory of lexicosemantic organization, semantic representations are neurally distributed and anatomically linked to category-specific sensory areas. Previous functional neuroimaging studies have demonstrated category specificity in lexicosemantic representations. However, little evidence is available from word generation paradigms, which provide access to semantic representations while minimizing confounds resulting from low-level perceptual features of stimulus presentation. In this study, 13 healthy young adults underwent fMRI scanning while performing a word generation task, generating exemplars to nine different semantic categories. Each semantic category was assigned to one of three superordinate category types, based upon sensorimotor modalities (visual, motor, somatosensory) presumed to predominate in lexical acquisition. For word generation overall, robust activation was seen in left inferior frontal cortex. Analyses by sensorimotor modality categories yielded activations in brain regions related to perceptual and motor processing: Visual categories activated extrastriate cortex, motor categories activated the intraparietal sulcus and posterior middle temporal cortex, and somatosensory categories activated postcentral and inferior parietal regions. Our results are consistent with the sensorimotor theory, according to which lexicosemantic representations are distributed across brain regions participating in sensorimotor processing associated with the experiential components of lexicosemantic acquisition.     

The impact of affect and frequency on lexical decision: the role of the amygdala and inferior frontal cortex

The current study used event-related fMRI to examine BOLD responses associated with two factors that behaviorally determine speed of lexical decision: frequency and emotion. Thirteen healthy adults performed a visual lexical decision task, discriminating between words and orthographically and phonologically legal nonwords. The study involved a 2 (Frequency: high and low) x 3 (Emotional arousal: highly negative, mildly negative, and neutral words) design with word categories matched for number of letters and concreteness. There were significant main effects for both frequency and emotion in lexical decision reaction times but no significant interaction. Negative word lexical decisions were associated with increased activation in bilateral amygdala and middle temporal cortex as well as rostral anterior and posterior cingulate cortex. Low-frequency word lexical decisions, relative to high-frequency word lexical decisions, were associated with increased bilateral activity in inferior frontal cortex. Inferior frontal cortex activation was particularly low during lexical decision for high-frequency emotional words but significant for high-frequency neutral emotional words. We suggest that this is because the semantic representation of high-frequency emotional words may receive sufficient additional augmentation via the reciprocal activation from the amygdala such that selective augmentation by inferior frontal cortex to achieve lexical decision is unnecessary.     

Exploring generalisation processes following lexical retrieval intervention in primary progressive aphasia

Abstract

Purpose: Within the current literature, positive intervention effects demonstrate the significant potential for people with Primary Progressive Aphasia (PPA) to learn/relearn words. Generalisation of intervention effects to other words and/or other contexts, however, remains unclear.

Method: This multiple baseline, case-series design investigated the effects of a self-cueing lexical retrieval intervention across word classes (nouns, verbs and adjectives) on four individuals with PPA, three suggestive of the semantic variant and one of the logopenic variant. The intervention integrated semantic, phonological and orthographic levels of language production and drew on autobiographical memory. Changes in accuracy in retrieving treated and untreated items (pre-intervention, post-intervention and 4-weeks maintenance) were determined using the Cochran’s Q test, with follow-up McNemar pairwise comparisons.

Result: All participants showed significant improvements in naming treated items, across all word classes. Different patterns of generalised improvement to untreated words were found for each participant. In discourse, the semantic variant participants demonstrated a significant increase in correct information units, in contrast to the participant with the logopenic variant who remained stable.

Conclusion: This study provides evidence that people with PPA can show improved lexical retrieval following intervention. The findings suggest possible differences in generalisation across word classes and according to underlying deficit.     

Discourse analysis: theoretical and historical overview and review of papers in the Journal of Advanced Nursing 1996-2004

AIM: The aim of the paper is (1) to offer an overview of different theoretical approaches to discourse analysis and (2) to review papers published in the Journal of Advanced Nursing from 1996-2004 in which discourse analysis is identified as a method of data analysis. BACKGROUND: Discourse analysis offers rigorous approaches to analysing naturally occurring talk and texts. Forms of discourse analysis have developed across broad theoretical bases. Such development has created challenges for researchers wishing to adopt this methodology and readers wishing to evaluate the quality of discourse analytic work. METHODS: First, key documents which describe the theoretical range of discourse analysis are used to provide (i) a comprehensive overview of the approach, (ii) the identification of categories of discourse analysis and (iii) minimum criteria for determining if an individual paper can realistically claim to be adopting discourse analysis. Secondly, an electronic search followed by hand search of the Journal of Advanced Nursing full-contents between 1996 and 2004 was undertaken. The papers were grouped into the types of approach identified in i, and evaluated to see whether they met the 'minimum criteria' also identified in i. FINDINGS: The search of Journal of Advanced Nursing revealed 24 papers where the authors stated that discourse analysis was among the methods or was the sole method of data analysis. The majority of the papers cluster around critical approaches to discourse analysis. Only a few approach discourse analysis primarily as analysis of conversation. Some papers are excellent, while others offer analysis that bears little resemblance to any form of discourse analysis. CONCLUSIONS: A strategy for improvement could include more rigorous attention on the part of those practising discourse analysis to methodology and the key features that differentiate the different approaches to discourse analysis from other qualitative methods. Authors should include sufficient detail of their approach.     

“I remember when … ”: The impact of reminiscence therapy on discourse production in older adults with cognitive impairment

Abstract

Purpose: Positive outcomes following reminiscence therapy have been reported for older adults with mild cognitive impairment and dementia in cognition and quality of life and, in a small number of studies, communication. Despite the close relationship between cognition and language, the impact on communication has received limited attention. This study aimed to investigate whether the spoken discourse of older adults with mild cognitive impairment or dementia could be improved within the genre of nostalgic recounts following group reminiscence therapy, and whether change generalised to everyday discourse.

Method: Four females (mean: 87 years, SD: 7.3) who lived in a residential aged care facility and were diagnosed with mild (n?=?2) or major (n?=?2) neurocognitive impairment were recruited to attend a group reminiscence programme delivered in eight one-hour treatment sessions over four weeks. Multiple baseline samples of discourse were obtained in the week prior to intervention to monitor stability. Macrostructure, rate, informativeness and efficiency of discourse production were measured to identify change within nostalgic recounts and monitor evidence of generalised change in everyday discourse genres. Cognitive performance and quality of life were also monitored.

Result: While variability was evident, significant increases in macrostructure and richness of nostalgic recounts were found for two participants, with significant generalisation to everyday discourse. Both participants had diagnoses of mild cognitive impairment. No significant improvements were seen in cognition or quality of life with all participants.

Conclusion: This study provides promising evidence for the spoken recall of memories having the potential to improve the communication of people with neurocognitive disorders, with some indication that people with milder impairment may be more amenable to this form of intervention. Nostalgic recounts may provide an explicit context in which speech-language pathologists can facilitate the planning of spoken production in people with cognitive impairment, and influence speaking in everyday contexts.     

Recognising pain in older adults living in sheltered accommodation: the views of nurses and older adults

Sixty-six randomly selected older adults and their contact nurses participated in interviews based on standardised assessments of pain and open-ended questions focusing how pain was expressed and recognised. The sample included older adults with normal as well as cognitively impaired function. Seventy-nine percent of older adults with normal cognition were often in pain. Contact nurses assessed pain in 57% of cognitively impaired older adults. The content in the statements showed that pain recognition was a communicative interactive process based on verbal and non-verbal expressions. The process comprised attempts to understand the cause and intention of the expression and to verify the presence of pain. Changes in mood, facial expressions and physiological responses were described less often by older adults than by their nurses. Contact nurses of cognitively impaired older adults judged immobility as the source of pain, that it was possible to see when the person was in pain and that pain was expressed by paralinguistic and body language more often than contact nurses of cognitively healthy older adults. Characteristics of nurses and older adults could facilitate or hinder pain recognition. The findings indicate a need for reflective discussions in the staff group focusing on how to perform systematic assessments of verbal and non-verbal expressions and of hindrances and facilitators for recognising pain in older adults.     

The activity of the von Willebrand factor cleaving protease ADAMTS-13 in newborn infants

Summary.  Background : Unusually large von Willebrand factor (VWF) multimers have been observed in patients with thrombotic microangiopathies (TMA), and absence of the VWF cleaving protease ADAMTS-13 activity is considered to be involved in the etiology of TMA. Increased amounts of large multimers of VWF have also been identified in neonates. Objective : We assessed ADAMTS-13 activity in healthy neonates, children and adults to establish baseline levels. Patients and methods : Cord blood was collected from 38 full-term newborns; venous samples were taken from 15 neonates on day 2–3 of life. Seventeen children, 24 healthy adults and seven patients with TMA were studied as well. ADAMTS-13 activity was quantified by the binding of the subjects' plasma VWF to collagen before and after enzyme activation. The multimer distribution of VWF was also determined. Results : Neonates and children had percentage ADAMTS-13 activity similar to adults. However, two groups were apparent in the cord blood samples: while 28/38 newborns had percentage activity within the normal range of healthy adults (102 ± 3.0%), 10 had significantly lower percentage activity (53 ± 1.1%; P  < 0.0001) that normalized by day 2–3. The VWF multimer distribution was the same in all cord blood samples and was not different compared with children and adults. High-molecular-weight VWF multimers were significantly increased in the 2–3-day-old neonates and in TMA patients. Conclusions : Although ADAMTS-13 activity was similar in neonates compared with adults, 26% of neonates had mildly reduced activity. Further studies are needed to investigate the complex interaction of VWF production and secretion with its size control by ADAMTS-13 in different age groups.