Developing Evidence-Based Treatment for Agraphia

开发基于证据的失写症治疗方法

• 批准号: 6959419
• 负责人: PELAGIE M BEESON
• 金额: $ 28.91万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6959419
• 关键词: brain injury; clinical research; cognition; human subject; language development; meta analysis; neural information processing; phonology; semantics; spelling

Most individuals with acquired language impairments experience difficulty in both written and spoken language. However, research on the rehabilitation of written language has lagged behind that designed to improve spoken language. A number of studies document the therapeutic value of behavioral treatment for acquired impairments of spelling (agraphia), but the evidence is not adequate to guide treatment selection for a particular patient or to inform expectations regarding the magnitude of change effected by treatment. Recent advances in the understanding of the cognitive processes and neural substrates that support written language provide a framework to guide treatment approaches for agraphia. Our work to date has shown that spelling involves lexical-semantic and phonological processes engaging relatively distinct neural substrates that can be differentially impaired by focal brain damage. With regard to the treatment of acquired impairments of spelling, we hypothesize the following: (1) Individuals with damage to left perisylvian language areas will have impaired phonological abilities with relative preservation of orthographic knowledge, and their spelling performance will improve in response to phonological treatment. (2) Individuals with damage to left posterior extrasylvian language areas will have impaired orthographic knowledge with relatively spared phonological abilities, and their spelling will improve in response to interactive treatment to promote optimal use of residual lexical-semantic and phonological knowledge. (3) Individuals with extensive left hemisphere damage will have significant impairment to both phonological and lexical-semantic processes, and their spelling will improve in response to a lexical treatment approach that involves releaming of specific orthographic representations. To test these hypotheses, we will examine three treatment protocols for acquired agraphia that specifically target lexical, phonological, or interactive spelling procedures. Single-subject experiments will be replicated across participants, with meta-analyses implemented for each treatment. We anticipate that this research will provide evidence-based treatment protocols for acquired impairments of spelling and guidelines for optimal candidacy and implementation. The findings should further clarify understanding of the cognitive processes and neural substrates that support spelling and recovery of function following brain damage.

大多数患有后天语言障碍的人在书面语言和口语方面都遇到困难。然而，关于书面语言康复的研究已经落后于旨在改善口语的研究。许多研究证明了行为治疗对后天性拼写障碍（失写症）的治疗价值，但证据不足以指导特定患者的治疗选择或告知治疗影响的变化幅度的预期。认知过程和支持书面语言的神经基质的理解的最新进展提供了一个框架，指导失写症的治疗方法。我们迄今为止的工作 拼写涉及词汇语义和语音过程，涉及相对不同的神经基质，可以通过局部脑损伤而不同地受损。关于后天性拼写障碍的治疗，我们假设如下：（1）左侧大脑外侧裂周围语言区受损的个体在相对保留正字法知识的情况下，其语音能力受损，并且他们的拼写表现会在语音治疗的反应中得到改善。(2)左后外侧裂语言区受损的人，其正字法知识受损，语音能力相对较弱，他们的拼写将在互动治疗后得到改善， 促进最佳利用剩余的词汇语义和语音知识。(3)左半球广泛损伤的个体在语音和词汇语义过程方面都会有明显的损伤，他们的拼写会在词汇治疗方法中得到改善，包括对特定的正字法表征进行重新命名。为了验证这些假设，我们将研究三个治疗方案，获得性失写症，专门针对词汇，语音，或互动拼写程序。单受试者实验将 在参与者中复制，并对每种治疗进行荟萃分析。我们预计，这项研究将提供以证据为基础的治疗方案获得性损害的拼写和指导方针的最佳候选人和实施。这些发现应该进一步澄清对认知过程和支持拼写和脑损伤后功能恢复的神经基质的理解。