超早期护理干预对脑功能区胶质瘤病人术后运动性失语的有效性分析

目的 探讨超早期(术后72 h内)护理干预对脑功能区胶质瘤病人术后失语的有效性,进一步明确脑功能区胶质瘤术后失语病人的更优护理干预时间点.方法 选择38例脑功能区胶质瘤术后失语病人,随机字母法分组为超早期护理干预组和常规护理对照组各19例并进行相应干预,使用波士顿诊断性失语检查法(BDAE)进行语言分级,分别比较两组失语病人干预后1周、干预后1个月语言康复效果.结果 所有病人均未出现护理干预相关严重不良事件.超早期干预护理组干预后1周语言康复临床有效率为84.2%,显著高于对照组的52.6%(P<0.05).超早期干预护理组干预后1个月临床有效率为94.7%,显著高于对照组的语言康复临床有效率68.4%(P<0.05).结论 超早期护理干预可提高脑功能区胶质瘤术后失语病人的语言康复效果,是脑功能区胶质瘤术后失语病人更佳的护理干预时间点,应提倡临床推广.     

Reversal of ear advantage in recovery from aphasia: a case report

A reversal from a left ear advantage to a right ear advantage on a digit dichotic listening test was observed during the first 3 months post-onset of aphasia in a 52-yr-old male patient. Explanations for this pattern of recovery were discussed under both a "lesion effect" and a "dominance effect" interpretation.     

Self-management of aphasia: a scoping review

Background: Self-management approaches are routinely used in chronic conditions to enable patients to take responsibility for their own care. A self-management approach may be appropriate for individuals with aphasia, but this has not been systematically investigated. The purpose of this review was to explore self-management in relation to aphasia.

Aims: The study aimed to explore existing research and intervention approaches for aphasia that incorporate self-management principles. A secondary aim was to examine the presence of the term self-management in the research literature and online resources relating to aphasia.

Methods & Procedures: A scoping review methodology was selected to explore literature relating to self-management of aphasia. Five databases were systematically searched in May 2017: PubMed, Embase, CINAHL, PsycINFO, and Linguistics & Language Behaviour Abstracts. Search terms used were aphasia OR dysphasia AND self-management OR self-directed OR self-care OR self-efficacy OR independence OR independent AND intervention OR treatment OR rehabilitation. A structured website search of aphasia, speech pathology and stroke associations from four English-speaking countries was performed in September 2017.

Outcomes & Results: A total of 43 studies met inclusion criteria for the literature review. Analysis of eligible studies showed three areas of aphasia intervention which incorporated principles self-management: 1) technology-based interventions, 2) group/community-based interventions, and 3) communication partner training. The structured website search revealed no information relating specifically to aphasia self-management.

Conclusions: Principles of self-management are being used in some aphasia interventions, but there is little evidence of a self-management approach being applied in aphasia. The term self-management is not widely present in aphasia literature and when it has been used tends to refer to self-administered treatment rather than a structured self-management approach.     

A compensatory role for declarative memory in neurodevelopmental disorders

Most research on neurodevelopmental disorders has focused on their abnormalities. However, what remains intact may also be important. Increasing evidence suggests that declarative memory, a critical learning and memory system in the brain, remains largely functional in a number of neurodevelopmental disorders. Because declarative memory remains functional in these disorders, and because it can learn and retain numerous types of information, functions, and tasks, this system should be able to play compensatory roles for multiple types of impairments across the disorders. Here, we examine this hypothesis for specific language impairment, dyslexia, autism spectrum disorder, Tourette syndrome, and obsessive–compulsive disorder. We lay out specific predictions for the hypothesis and review existing behavioral, electrophysiological, and neuroimaging evidence. Overall, the evidence suggests that declarative memory indeed plays compensatory roles for a range of impairments across all five disorders. Finally, we discuss diagnostic, therapeutic and other implications.     

A new life with aphasia: everyday activities and social support

People who develop aphasia must adjust their lifestyles and learn to cope with the activity limitations that may follow from their disability. The purpose of this study was to describe aphasic individuals' experiences of everyday activities and social support in daily life. Interviews were conducted with 20 people with aphasia, and analysed with qualitative content analysis. The results show that everyday activities changed considerably with the onset of aphasia, and the participants were hindered from participating in activities by communication problems or physical disabilities. Aphasia led to the loss of friends and colleagues, and the interviewees often felt lonely. They generally received a lot of social support from close relatives, but support from the healthcare system was lacking. They need different kinds of social support to help them manage their aphasia and everyday activities and to improve their participation in society. Further studies are needed to improve our knowledge of everyday activity and social support for people with aphasia, and what it means to live with aphasia.     

卒中后失语的药物治疗

卒中后失语是由卒中导致的获得性语言障碍,严重影响患者的社交能力并降低其生活质量,给社会和家庭都带来很大负担.传统的治疗方法没有肯定的疗效,因此失语的药物治疗备受关注.文章就卒中后失语的药物治疗研究进展进行了综述.     

Brain regions underlying repetition and auditory-verbal short-term memory deficits in aphasia: Evidence from voxel-based lesion symptom mapping

Background: A deficit in the ability to repeat auditory-verbal information is common among individuals with aphasia. The neural basis of this deficit has traditionally been attributed to the disconnection of left posterior and anterior language regions via damage to a white matter pathway, the arcuate fasciculus. However, a number of lesion and imaging studies have called this notion into question.

Aims: The goal of this study was to identify the neural correlates of repetition and a related process, auditory-verbal short-term memory (AVSTM). Both repetition and AVSTM involve common elements such as auditory and phonological analysis and translation to speech output processes. Based on previous studies, we predicted that both repetition and AVSTM would be most dependent on posterior language regions in left temporo-parietal cortex.

Methods & Procedures: We tested 84 individuals with left hemisphere lesions due to stroke on an experimental battery of repetition and AVSTM tasks. Participants were tested on word, pseudoword, and number-word repetition, as well as digit and word span tasks. Brain correlates of these processes were identified using a statistical, lesion analysis approach known as voxel-based lesion symptom mapping (VLSM). VLSM allows for a voxel-by-voxel analysis of brain areas most critical to performance on a given task, including both grey and white matter regions.

Outcomes & Results: The VLSM analyses showed that left posterior temporo-parietal cortex, not the arcuate fasciculus, was most critical for repetition as well as for AVSTM. The location of maximal foci, defined as the voxels with the highest t values, varied somewhat among measures: Word and pseudoword repetition had maximal foci in the left posterior superior temporal gyrus, on the border with inferior parietal cortex, while word and digit span, as well as number-word repetition, were centred on the border between the middle temporal and superior temporal gyri and the underlying white matter.

Conclusions: Findings from the current study show that (1) repetition is most critically mediated by cortical regions in left posterior temporo-parietal cortex; (2) repetition and AVSTM are mediated by partially overlapping networks; and (3) repetition and AVSTM deficits can be observed in different types of aphasia, depending on the site and extent of the brain injury. These data have implications for the prognosis of chronic repetition and AVSTM deficits in individuals with aphasia when lesions involve critical regions in left temporo-parietal cortex.     

The neural representation of language in users of American Sign Language

Studies of American Sign Language (ASL) offer unique insights into the fundamental properties of human language. Neurolinguistic studies explore the effects of left and right hemisphere lesions on the production and comprehension of signed language. Following damage to the left hemisphere perisylvian regions, signers, like users of spoken languages, exhibit frank aphasic disturbances. Sign language paraphasia illustrates the linguistic specificity of impairment. A case study involving cortical stimulation mapping (CSM) in a deaf signer provides evidence for the specialization of Broca's area in sign language production. The effects of right hemisphere damage highlight the specialized properties of sign language use. Data from functional magnetic resonance imaging (fMRI) of deaf signers confirm the importance of left hemisphere language structures in the use of signed language, but also reveal the contributions of right hemisphere regions to the processing of ASL. These studies provide new insights into the complementary roles of biology and environment in language representation in the human brain. Learning Outcomes: As a result of this activity, the participant will read studies of aphasia in users of signed language and a discussion of neurolinguistic studies of paraphasia in ASL. The participant will examine the role of the right hemisphere in language use and findings from a functional imaging study of sentence processing in ASL and English.     

脑卒中失语症和阿尔茨海默病的语义记忆损害的研究

目的分析脑卒中失语症和阿尔茨海默病的字词理解障碍的特点,探索语言在脑内的加工过程的神经机制和指导言语康复锻炼。方法采用词画匹配的方法,比较脑卒中失语症患者和阿尔茨海默病患者在呈现时间、语义相关性、字词频率、反应一致性4种条件下的字词理解的成绩。结果呈现时间作用、语义相关性作用影响失语症患者的理解成绩。字词频率是决定阿尔茨海默病患者成绩的一个主要因素。反应不一致性是失语症患者的特点,而在阿尔茨海默病患者中没有观察到反应不一致性。结论脑卒中失语症患者的字词理解障碍,是由于对已存贮的语义表象的再现受损;阿尔茨海默病患者的字词理解障碍,系由于已存贮的语义表象本身缺陷。