卒中后失语患者非语言认知功能损害特点的临床研究

目的 探讨卒中后失语患者非语言认知功能损害的特点，并分析卒中后失语患者语言障碍与非语言 性认知功能损害之间的关系。 方法 选择2017年5月-2018年6月就诊的卒中患者共32例，经西方失语症成套测验（western aphasia battery，WAB）评估语言功能，分为失语组和无失语组，其中失语组15例，无失语组17例。洛文斯顿成 套测验中文版（Loewenstein occupational therapy cognitive assessment，LOTCA）第2版评估患者非语言认 知功能。对失语组与非失语组的LOTCA各分项分值及总分分别进行非参数检验；对WAB中各分项得 分及失语商与LOTCA各认知分项得分及总分进行偏相关分析，并行多元逐步回归分析。 结果 失语组的LOTCA总分低于无失语组，差异有统计学意义[85.0（69.0～92.0）分 vs 99.0 （86.0～102.5）分，P <0.05]；失语患者LOTCA总分与WAB各分项及失语商呈正相关（r =0.587～0.883， 均P <0.05），WAB分项中的各分项与LOTCA中各分项之间呈正相关（r =0.521～0.843，均P <0.05）；多 元逐步回归分析显示，影响患者失语商的主要因素为LOTCA总分（β=0.707，P =0.003）。 结论 卒中后失语患者存在非语言认知功能障碍，失语程度越重其非语言认知功能受损程度越重。     

Word form encoding is under attentional demand: evidence from dual-task interference in aphasia

Although speakers can go on producing utterances while doing concurrent tasks, language planning is affected in conditions of divided attention. It is however unclear whether a concurrent task impacts only lexical selection, or if post-lexical processing is also impacted. To elucidate this question, we reasoned that if an encoding process is under attentional control, this should be even more the case when the planning process is disrupted due to brain damage: increased error rates in left-hemisphere damaged participants under dual-task conditions should therefore shed light on which encoding processes need attentional resources. Twelve participants producing either predominantly lexical or phonological errors following left-hemisphere stroke and eleven matched healthy controls underwent a dual-task picture naming paradigm with a concurrent auditory verbal and non-verbal task. The results indicate an impact of active dual-tasks on word production in both controls and aphasic participants, but a magnified effect on errors in aphasic participants with an overall increase of phonological errors under dual-task conditions. These results suggest that post-lexical encoding processes are under attentional demand.     

Persian Verb and Sentence Production Protocol (PVSP) and its efficacy on Persian-speaking agrammatic non-fluent persons with aphasia

ABSTRACT

Background: The semantic/syntactic representation of the verb is directly correspondent with the information required for generating well-constructed messages. Although various verb and sentence impairment therapies for persons with aphasia (PWA) are presented, there has been no published study of Persian verb treatment protocol for linguistic and cross-linguistic purposes.

Aims: This study was aimed at introducing a verb treatment protocol founded upon the Persian syntax, teaching to link the key thematic information of verbs, and targeting treatment at the word and sentence level.

Methods & Procedures: A single-subject study with multiple baselines design across participants was conducted. The efficacy of Persian Verb and Sentence Production Protocol (PVSP) on three agrammatic non-fluent patients was examined. Verb production skills at the word and sentence level were examined. The Mean Sentence Length (MSL) and sentence production across different tasks were measured at baseline and daily treatment probes.

Outcome and Results: Three participants notably improved in verb percent production at the word level in experimental items (from 3.3% to 88% for participant 1, from 1.17% to 27.6% for participant 2 and from 3.75% to 58.6% for participant 3). Generalisation to control items were observed (from 10% to 81.2% for participant 1, from 24.9% to 52.98% for participant 2, from 19.7% to 60.89% for participant 3). All participants also enhanced in verb percent production at the sentence level in experimental items (from 13.3% to 67% for participant 1, from 16.6% to 40% for participant 2, and from 5.7% to 55% for participant 3). Generalisation to control items was noted (from 20% to 57% for participant 1, from 23.3% to 43.5% for participant 2, from 5% to 61% for participant 3). The results of the maintenance and follow-up phases were subsequently remarkable. Pre-post measures of MSL in connected speech (free speech) were improved outstandingly (from 1 to 4.3 for participant 1, from 3.5 to 8 for participant 2, from 0 to 5.2 for participant 3).

Conclusions : PVSP seems to be beneficial to various degrees for Persian-speaking agrammatic non-fluent patients, enhancing their verb retrieval and sentence making skills.     

Relations between executive function,language, and functional communication in severe aphasia

Background: Intervention in severe aphasia often means aiming for access to meaningful social interaction in spite of linguistic barriers that might not be treatable. This demands knowledge about the different factors that influence functional communication. Apart from linguistic ability, executive functions are thought to play an important role.

Aims: To expand the understanding of the relations of executive functions and linguistic ability to functional communication in severe aphasia.

Methods and Procedures: Executive functions, linguistic ability, and functional communication were assessed in 47 participants with severe aphasia. The results were analysed for the total sample and for a verbal and a nonverbal subgroup.

Outcomes and Results: Impairment of executive function was found in 85% of the participants. There were moderate to strong correlations between all subtests of executive functions and linguistic ability. In the total sample, significant partial correlation was found between functional communication and verbal output. In the nonverbal subgroup, there was a significant partial correlation between executive function and functional communication, when controlling for linguistic ability. In the verbal subgroup, no relations were found between executive functions or language and functional communication.

Conclusions: Impairments of executive functions are common in people with severe aphasia, and executive function and linguistic ability are closely related. The ability to produce verbal output is strongly related to functional communication, but in people with extreme limitation or total absence of verbal output, executive functions seem to be an important factor for functional communication. There is a large variation of executive functions and functional communication in people with severe aphasia, especially in the nonverbal subgroup. It is important that people with severe aphasia are given a complete and proper evaluation of their abilities, and that the possible importance of executive function to communication is considered in communication intervention.     

Speak along without the song: what promotes fluency in people with aphasia?

ABSTRACT

Background: Melodic intonation therapy (MIT) is a widely used treatment for nonfluent aphasia that builds upon a number of musical elements in order to ultimately improve generative language. These include intoning syllables on different pitches, using a metrically regular speech rhythm, and the clinician and patient producing phrases in unison. Studies have investigated which of these musical elements might be the most clinically facilitating, but important differences in methodology and results across studies leave some questions unanswered. In particular, the relative roles of intoning and unison production remain unclear.

Aims: The present study examined these elements in isolation and in combination.

Methods & Procedures: Twelve people with aphasia (PWA) and 10 control participants sang and rhythmically spoke unfamiliar song lyrics in unison with a recording and by themselves. A subset of eight of the PWA returned for post-hoc testing to evaluate singing familiar lyrics from memory, and propositional speech. Across all tasks, productions were evaluated for syllable accuracy.

Outcomes & Results: On average, PWA benefited from unison over solo production and from rhythmic speech over singing when repeating unfamiliar lyrics. They did show a benefit of singing when producing familiar lyrics from memory, but this post-hoc task did not control for syllable duration or task order. Within-group correlations indicated that those with more severe apraxia of speech, worse single-word auditory comprehension, and poorer repetition ability benefited the most from unison production. Those with better sentence-level auditory comprehension and poorer performance on a perceptual rhythm test tended to benefit more from singing compared to rhythmically speaking unfamiliar lyrics.

Conclusions: Unison production is an important element for promoting fluency in many PWA, and perhaps especially for those for whom MIT is considered an appropriate treatment option. However, some candidates for MIT are hindered by the inclusion of even moderately complex melodic information, indicating that this factor should be considered when customizing or adapting the therapy. Finally, PWA who show a striking improvement in fluency when singing familiar songs will not necessarily benefit from singing when the aim is to produce new lyrics or propositional content.     

双语加工神经机制与双语失语康复

<正>掌握双语或多语者由于大脑损害致言语功能损害或缺失称为双语或多语失语[1-2]。随着双语失语人群的不断增加,对康复治疗产生迫切需求,选择何种语言进行康复治疗更佳成为亟待解决的问题。既往基于临床表现和神经定位的失语分类和康复指导理论已经无法解决目前双语失语的康复问题。本文基于双语加工神经机制,对目前双语恢复模式和康复语种模式进行评述,并思考和简述双语失语的康复方向。一、双语界定目前关于双语的界定尚无完全统一标准,传统     

Cross-linguistic adaptations of The Comprehensive Aphasia Test: Challenges and solutions

ABSTRACT

Comparative research on aphasia and aphasia rehabilitation is challenged by the lack of comparable assessment tools across different languages. In English, a large array of tools is available, while in most other languages, the selection is more limited. Importantly, assessment tools are often simple translations and do not take into consideration specific linguistic and psycholinguistic parameters of the target languages. As a first step in meeting the needs for comparable assessment tools, the Comprehensive Aphasia Test is currently being adapted into a number of languages spoken in Europe. In this article, some key challenges encountered in the adaptation process and the solutions to ensure that the resulting assessment tools are linguistically and culturally equivalent, are proposed. Specifically, we focus on challenges and solutions related to the use of imageability, frequency, word length, spelling-to-sound regularity and sentence length and complexity as underlying properties in the selection of the testing material.     

Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA.

Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs.

Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs.

Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former.

Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff.     

Cognitive grammar and aphasic discourse

In cognitive grammar (CG), there is no clear division between language and other cognitive processes; all linguistic form is conceptually meaningful. In this pilot study, a CG approach was applied to investigate whether people with aphasia (PWA) have cognitive linguistic difficulty not predicted from traditional, componential models of aphasia. Narrative samples from 22 PWA (6 fluent, 16 non-fluent) were compared with samples from 10 participants without aphasia. Between-group differences were tested statistically. PWA had significant difficulty with temporal sequencing, suggesting problems that are not uniquely linguistic. For some, these problems were doubly dissociated with naming, used as a general measure of severity, which indicates that cognitive linguistic difficulties are not linked with more widespread brain damage. Further investigation may lead to a richer account of aphasia in line with contemporary linguistics and cognitive science approaches.