How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.
How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.
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DOI：
10.3389/fnhum.2013.00035
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发表时间：
2013
影响因子：
2.9
通讯作者：
Kotz SA
中科院分区：
文献类型：
--
作者：
Stahl B;Henseler I;Turner R;Geyer S;Kotz SA
关于唱歌是否可以通过刺激右半球帮助左半球中风患者从非流利性失语症中恢复，目前一直存在争论。根据最近的研究，对于不流利的失语症患者来说，帮助言语产生的可能不是歌唱本身，而是节奏和抒情类型。然而，旋律和节奏对言语恢复的长期影响在很大程度上尚不清楚。在当前的实验中，我们测试了 15 名患有慢性非流利性失语症的患者，他们接受了歌唱疗法、节奏疗法或标准言语疗法。该实验控制了发声质量、声音频率变异性、音高准确性、音节持续时间、语音复杂性和其他影响，例如测试本身引起的声学设置和学习效果。研究结果提供了第一个证据，证明唱歌和有节奏的言语对于治疗不流利的失语症可能同样有效。这一发现可能会挑战唱歌导致语言功能从左半球转移到右半球的观点。相反，唱歌和节奏治疗的患者在产生常见的、公式化的短语方面都取得了良好的进步——已知这些短语是由右皮质纹状体大脑区域支持的。这一进展发生在两种疗法的早期阶段，并且随着时间的推移保持稳定。相反，接受标准治疗的患者在表达公式化短语方面进展较小。然而，他们确实提高了非公式化言语的表达能力，而接受唱歌和节奏治疗的患者则没有。鉴于这些结果，可能值得考虑结合使用标准疗法和公式化短语的训练，无论是唱歌还是有节奏地说。标准疗法可能会特别涉及左侧病变周围的大脑区域，而公式化短语的训练可能会开辟利用右半球语言资源的新方法——即使不唱歌。
There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases—known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources—even without singing.
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