A Prospective, Controlled Study of Rehabilitation of Anomia in Aphasia

描述(由申请人提供)： 失语症最常见和最令人衰弱的特征之一是提取单词的能力受损，无论是命名看到的物体，还是在自发的命题言语中产生表达意义的名词、动词和其他单词。这项研究的长期目标是为中风后天性失语症患者建立一种有效、可行、循证的单词提取缺陷治疗计划。这个项目的短期目标和重点是进行最终的第二阶段试验，测试实验性治疗(称为语音运动)与常规和常规治疗(即基于语义的治疗)对失语症失调症的疗效。在双臂对照试验的背景下，我们建议对80名患有左半球中风并表现出明显失语的失语症患者进行总计60小时的治疗。治疗获得和推广的效果将在3个时间点(立即、治疗结束后3个月和1年后)进行评估。本研究的主要目的是在3个月后解决未训练名词的对峙命名成绩的组间差异。次要问题将涉及对生态有效性和话语生产的衡量标准的处理泛化。通过一系列的阶段I和阶段II的实验，我们已经表明，集中传授的音素处理不仅提高了对已训练单词的对峙命名成绩，而且，正如激发它的理论所预测的那样，重要的是实现了对未训练单词的命名、话语产生的某些方面和生活质量的指标的泛化。治疗计划是由音系学的联结主义模式(Nadeau，2001；Nadeau，2006，Nadeau，2012)和语言的两级互动模式(Dell，1987)推动的。音素运动处理的理论基础是：通过对音素(声音)和音素序列的系统训练，增强支持音素序列知识的神经连通性。因为这些声音序列为代表概念的单词提供了基础，通过在语言水平之间和语言水平之间双向地传播激活，从处理音素的概括可以预期改善未经训练的单词的命名和语篇产生，既在治疗之后立即和在治疗终止之后继续。

DESCRIPTION (provided by applicant): One of the most common and debilitating features of aphasia is an impairment in ability to retrieve words, whether it involves naming seen objects, or producing nouns, verbs and other words conveying meaning in spontaneous propositional speech. The long-term goal of this line of research is to establish an effective, viable, evidence-based treatment program for word retrieval deficits in persons with acquired aphasia from stroke. The short-term goal, and focus of this project, is to conduct a final phase II trial that tests the efficacy of an experimental treatent (called phonomotor) against customary and usual treatment (i.e. semantic-based therapy) for anomia in aphasia. In the context of a 2-armed control trial, we propose to deliver 60 total hours of therapy to 80 individuals who have suffered a left hemisphere stroke and exhibit aphasia with significant anomia. Effects of treatment acquisition and generalization will be measured at 3 time points (immediately, 3-months and 1-year post treatment termination). The primary aim will address between group differences of confrontation naming performance of untrained nouns at 3 months. Secondary questions will address generalization of treatment to measures of ecologic validity and discourse production. Through a series of phase I and phase II trials, we have shown that intensively delivered phonomotor treatment not only improves confrontation naming performance on trained words but, as predicted by the theory motivating it, importantly achieves generalization to naming of untrained words, some aspects of discourse production, and indicators of quality of life. The treatment program is motivated by a connectionist model of phonology (Nadeau, 2001; Nadeau, 2006, Nadeau, 2012) and by a two level interactive model of language (Dell, 1987). The theoretical foundation for the phonomotor treatment is as follows: through the systematic training of phonemes (sounds) and phoneme sequences, the neural connectivity supporting phoneme sequence knowledge will be enhanced. Because these sound sequences provide the basis for the words that represent concepts, through bidirectional spread of activation among and between linguistic levels, generalization from treating phonemes can be expected to improve naming of untrained words and discourse production, both immediately after treatment and continued beyond treatment termination.