Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia
Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia
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DOI：
10.1162/0898929053279487
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发表时间：
2005-03-01
影响因子：
3.2
通讯作者：
Rothi, LJG
中科院分区：
文献类型：
--
作者：
Crosson, B;Moore, AB;Rothi, LJG
两例缺血性卒中后残余非流利性失语患者接受了意向治疗，目的是将意向和语言产生机制从受损的左半球额叶转移到右额叶。与实验假设一致，第一个病人在意向治疗上表现出改善，而在类似的注意治疗上没有。此外，与实验假设一致，患者表现出从意向治疗前到意向治疗后，语言产生的功能磁共振成像（fMRI）活动向右侧辅助运动区和右侧外侧额叶转移。相比之下，第二名患者在意向和注意力治疗方面都有所改善。在治疗前的功能磁共振成像中，她已经显示出意图和语言产生机制向右半球偏侧化，这种偏侧化持续到意图治疗后的成像中。从治疗前到治疗后的语言生成功能磁共振成像（fMRI）显示，两名患者都表现出后外围皮层的活动增加，尽管这种活动在第二名患者中偏侧到左半球语言区，而在第一名患者中没有。第一个病人的损伤几乎涵盖了所有的基底神经节和丘脑，而第二个病人的损伤却保留了这些结构，这一事实表明基底神经节可能在右半球语言产生功能的自发重组中起作用。讨论了意图治疗理论框架的含义。
Two patients with residual nonfluent aphasia after ischemic stroke received an intention treatment that was designed to shift intention and language production mechanisms from the frontal lobe of the damaged left hemisphere to the right frontal lobe. Consistent with experimental hypotheses, the first patient showed improvement on the intention treatment hut not on a similar attention treatment. In addition, in keeping with experimental hypotheses, the patient showed a shift of activity to right presupplementary motor area and the right lateral frontal lobe from pre- to post-intention treatment functional magnetic resonance imaging (fMRI) of language production. In contrast, the second patient showed improvement on both the intention and attention treatments. During pre-treatment fMRI, she already showed lateralization of intention and language production mechanisms to the right hemisphere that continued into post-intention treatment imaging. From pre- to post-treatment fMRI of language production, both patients demonstrated increased activity in the posterior perisylvian cortex, although this activity was lateralized to left-hemisphere language areas in the second but not the first patient. The fact that the first patient's lesion encompassed almost all of the dominant basal ganglia and thalamus whereas the second patient's lesion spared these structures suggests that the dominant basal ganglia could Play a role in spontaneous reorganization of language production functions to the right hemisphere. Implications regarding the theoretical framework for the intention treatment are discussed.