Developing Evidence-Based Treatment for Agraphia

开发基于证据的失写症治疗方法

• 批准号: 7454188
• 负责人: PELAGIE M BEESON
• 金额: $ 27.77万
• 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/7454188
• 关键词: Agraphia; Area; Basic Science; Behavior Therapy; Biological Preservation; Brain Injuries; Cognitive; Confidence Intervals; Data; Evidence based treatment; Guidelines; Impairment; Individual; Knowledge; Language; Learning; Left; Lesion; Letters; Measures; Memory; Meta-Analysis; Numbers; Orthography; Outcome; Participant; Patients; Performance; Procedures; Process; Protocols documentation; Recovery; Recovery of Function; Rehabilitation therapy; Relative (related person); Research; Residual state; Selection for Treatments; Semantics; Series; Testing; Therapeutic; Treatment Protocols; Work; Writing; base; design; expectation; experience; focal brain damage; functional status; hemisphere damage; improved; indexing; lexical; phonology; relating to nervous system; research study; response; semantic processing; size; sound; spelling; treatment effect

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和口语方面都会遇到困难。然而，对书面语言康复的研究落后于旨在改善口语的研究。许多研究记录了行为治疗对于获得性拼写障碍（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对治疗所影响的变化程度的预期。对支持书面语言的认知过程和神经基质的理解的最新进展为指导失写症的治疗方法提供了一个框架。迄今为止我们的工作已经 研究表明，拼写涉及词汇语义和语音过程，涉及相对不同的神经基质，这些神经基质可能因局灶性脑损伤而受到不同程度的损害。关于获得性拼写障碍的治疗，我们假设如下：（1）左外裂语言区受损的个体语音能力受损，拼字知识相对保留，并且他们的拼写表现会因语音治疗而得到改善。 (2) 左外侧外侧语言区受损的个体，其拼写知识会受损，而语音能力相对较差，并且他们的拼写会随着互动治疗而得到改善。 促进剩余词汇语义和语音知识的最佳利用。 (3) 左半球广泛损伤的个体的语音和词汇语义过程都会受到显着损害，并且他们的拼写将随着涉及重新学习特定拼写表征的词汇治疗方法而得到改善。为了检验这些假设，我们将研究三种针对获得性失写症的治疗方案，这些方案专门针对词汇、语音或交互式拼写程序。单受试者实验将 在参与者之间进行复制，并对每种治疗进行荟萃分析。我们预计这项研究将为获得性拼写障碍提供基于证据的治疗方案，并为最佳候选资格和实施提供指南。这些发现应该进一步阐明对支持拼写和脑损伤后功能恢复的认知过程和神经基质的理解。