Developing Evidence-Based Treatment for Agraphia

开发基于证据的失写症治疗方法

• 批准号: 7626704
• 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 2011-02-03
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7626704
• 关键词: Aftercare; 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; Orthography; Outcome; Participant; Patients; Performance; Procedures; Process; 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; 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.

大多数有后天语言障碍的人在书面和口头语言方面都遇到了困难。然而，关于书面语修复的研究一直落后于旨在提高口语水平的研究。许多研究记录了行为治疗对后天性拼写障碍(失写)的治疗价值，但证据不足以指导特定患者的治疗选择，也不足以告知有关治疗所影响的变化幅度的预期。在理解支持书面语言的认知过程和神经基础方面的最新进展为指导失写的治疗方法提供了一个框架。到目前为止，我们的工作有 研究表明，拼写涉及词汇-语义和语音过程，涉及到相对不同的神经底物，局灶性大脑损伤可能会造成不同的损害。关于后天获得的拼写障碍的治疗，我们假设如下：(1)左旁语言区受损的个体在相对保留正字法知识的情况下语音能力受损，其拼写成绩将因语音治疗而提高。(2)左侧后外侧语言区受损的个体拼写知识受损，语音能力相对较差，在交互作用下拼写能力得到改善。 促进剩余词汇、语义和语音知识的最佳使用。(3)左脑广泛受损的个体在语音和词汇-语义加工过程中都会有显著的损害，他们的拼写会因词汇处理方法而得到改善，这种方法包括释放特定的正字法表征。为了验证这些假设，我们将检验三种针对后天失写症的治疗方案，这些方案专门针对词汇、语音或交互拼写过程。单一受试者实验将是 在参与者中复制，对每个治疗实施荟萃分析。我们预计这项研究将为后天的拼写障碍提供循证的治疗方案，并为最佳候选资格和实施提供指导。这些发现应该会进一步澄清对大脑损伤后支持拼写和功能恢复的认知过程和神经基础的理解。