Learning Beyond Criterion in Aphasia Rehabilitation

描述(由申请人提供)：获得性阅读障碍(失读症)在左半球中风或头部损伤后的失语症患者中很常见。即使当语言功能恢复到足以使患者重返工作岗位时，未恢复的失读症通常也会严重干扰工作表现。无法重返工作岗位的患者可能几乎没有时间可用；恢复阅读能力将使他们的生活质量得到显著改善。影响患者重返工作岗位并维持良好生活质量的一个重要因素是成功的治疗。语言治疗通常被认为是有效的，如果患者在多次治疗中成功地完成了一系列特定标准的任务。实现这一目标意义重大；它表明学习已经发生，为患者提供了一种进步感，并促进了我们对大脑中语言处理的理解。然而，康复的一个基本组成部分很少得到足够的关注，那就是患者在治疗结束后保持所学技能的能力。本项目的目标是考察超越标准的培训对保持所学语言技能的影响。第二个目标是研究成功治疗后大脑功能的变化，并探索在延长额外练习时间后可能发生的任何额外变化。根据阅读的神经心理学模型，中风患者失语症治疗的成功取决于用于处理语言的认知和神经通路的重组；因此，fMRI技术可能有助于记录和阐明失语症治疗和延长练习如何带来加工过程的变化。该提案侧重于治疗两种特殊缺陷：纯失读症和音位性失读症。然而，正在研究的原则是一般性的，适用于一般的失语症治疗。在这些阅读障碍的治疗之前，将测量在某些阅读任务中的脑功能激活模式，然后在治疗完成后再次测量(通过达到标准表现来确定)。然后将实施为期8周的延长治疗，然后再次进行功能磁共振扫描。维持业绩将在6个月后重新评估。将评估延长治疗对维持的影响，并对在3个不同阶段获得的扫描进行比较。研究结果将提供有关延长治疗在语言治疗长期成功中的作用、功能磁共振成像扫描预测长期维持的可能性等重要信息，并将导致对失读症治疗后大脑影响认知变化的方式的重要见解。这些结果将对失语症康复计划的设计和实施具有重要的意义，这将对失读症和失语症患者的生活产生重大的积极影响。

DESCRIPTION (provided by applicant): Acquired reading disorders (alexias) are common in patients with aphasia subsequent to left hemisphere stroke or head injury. Even when language functions recover sufficiently to enable the patient to return to work, unrecovered alexia often significantly interferes with job performance. Patients who cannot return to work may be left with little to occupy their time; regaining the ability to read would make a significant improvement in their quality of life. An important factor affecting a patient's ability to return to work and sustain a good quality of life is successful therapy. A language therapy is generally considered to be effective if a patient succeeds in performing a set of tasks at a specific criterion level over a number of sessions. Attaining this goal is significant; it demonstrates that learning has occurred, provides the patient with a sense of progress, and advances our understanding of language processing in the brain. However, an essential component of rehabilitation that rarely receives sufficient attention is the patient's ability to maintain the learned skills after therapy is terminated. 1 goal of this project is to examine the effects of training beyond criterion performance upon the maintenance of learned language skills. A second goal is to investigate the functional changes in the brain that occur following successful treatment, and to explore any additional changes that may occur following such extended periods of additional practice. According to neuropsychological models of reading, the success of aphasia treatment in stroke patients is dependent upon the reorganization of the cognitive and neural pathways used to process language; thus, fMRI techniques may be useful in documenting and elucidating how changes in processing may be brought about by aphasia therapy and extended practice. The proposal focuses on treatment of 2 specific deficits: pure alexia and phonologic alexia. However, the principles being examined are general ones, and apply to aphasia therapies in general. Functional brain activation patterns during certain reading tasks will be measured prior to treatment for these alexic disorders, then again following completion of the treatment (as ascertained by the reaching of criterion performance). An 8-week period of extended treatment will then be implemented, followed once again by an fMRI scan. Maintenance of performance will be re-assessed at 6 months. Effects of extended treatment on maintenance will be assessed, and comparisons will be made between scans obtained at the 3 different stages. Results will provide important information regarding the role of extended treatment in long-term success of language therapy, the potential for fMRI scans to predict long-term maintenance, and will lead to important insights into the ways that the brain effects cognitive changes following treatment for alexia. These results will have important implications for the design and implementation of aphasia rehabilitation programs, which should have significant positive effects upon the lives of individuals with alexia and aphasia.