Remediation of Word Processing and Short-Term Memory Deficits in Aphasia

描述（由申请人提供）：失语治疗研究的一个重点是了解治疗内容如何与受损的单词表征相互作用（Nettleton & Lesser, 1992），以及如果治疗内容直接刺激受损的表征（例如，语义障碍的语义治疗），治疗是否更有效。这种关注很重要，但并没有解决单词检索的动态过程。我们建议研究一种治疗失语症的方法，该方法针对单词的语义和语音表征在语言理解和产生过程中被激活和维持的过程。这种关注是及时的，因为这些激活过程已经被描述和测试为文字处理模型中的失语损伤（例如，Dell, Schwartz, Martin, Saffran & Gagnon, 1997）和失语症中的言语短期记忆（STM）缺陷（Martin & Gupta, 2004）。此外，最近对失语症中听力-言语STM缺陷的治疗研究援引这些理论模型作为框架，将STM缺陷与失语症的理解和生产缺陷联系起来（Majerus, van der Kaa, Renard, Vander Linden & Poncelet, 2005）。因此，下面的模型通过激活过程的动态将两种缺陷联系起来（Martin & Saffran, 1997），我们将把这种联系扩展到专注于提高维持单词表征激活能力的治疗。该项目包括两个部分。首先，我们将获得来自失语症和非失语症患者的标准数据，通过诊断电池来评估激活和维持单个和多个单词话语的语义和语音表征的激活能力。其次，我们将测试一个治疗方案的有效性，以提高在短期记忆中激活和维持单个单词和多个单词话语的语义和/或语音表征的激活能力。治疗的效果将通过在多个刺激设计的多个基线中获取和维持探针来检验，并通过比较诊断电池和治疗任务的测试前后表现。这项研究应该对公众健康有重大的好处。虽然中风后的语言障碍通常是终身残疾，但基于对语言系统及其脑损伤后的崩溃的全面理解的治疗已经导致语言功能的改善，即使是在这种残疾的慢性阶段。这个项目将检查诊断电池和治疗项目对文字处理和短期记忆障碍的疗效，这两种障碍总是同时出现在失语症中。这个项目的独特之处在于，它检查和治疗在逐渐增加工作记忆压力的环境中的文字处理缺陷，从而更接近功能性交流发生的条件。这项研究应该对公众健康有重大的好处。虽然中风后的语言障碍通常是终身残疾，但基于对语言系统及其脑损伤后的崩溃的全面理解的治疗已经导致语言功能的改善，即使是在这种残疾的慢性阶段。

DESCRIPTION (provided by applicant): One focus of research in aphasia therapy has been to understand how the content of treatment interacts with impaired word representations (Nettleton & Lesser, 1992) and whether therapy is more effective if its content directly stimulates impaired representations (e.g., semantic therapy for semantic impairments). This focus is important, but does not address the dynamic processes of word retrieval. We propose to investigate an approach to treatment of aphasia that targets the processes by which semantic and phonological representations of words are activated and maintained during comprehension and production of language. This focus is timely, as these activation processes have been described and tested as accounts of aphasic impairment in models of word processing (e.g., Dell, Schwartz, Martin, Saffran & Gagnon, 1997) and verbal short-term memory (STM) deficits in aphasia (Martin & Gupta, 2004). Moreover, recent studies of treatments for auditory-verbal STM deficits in aphasia have invoked these theoretical models as a framework for linking STM deficits with comprehension and production deficits in aphasia (Majerus, van der Kaa, Renard, Vander Linden & Poncelet, 2005). Thus, following models that connect the two deficits by way of the dynamics of activation processes (Martin & Saffran, 1997), we will extend this connection to treatment that focuses on improving the ability to maintain activation of word representations. The project includes two parts. First, we will obtain normative data from aphasic and nonaphasic individuals on a diagnostic battery that assesses the ability to activate and maintain activation of semantic and phonological representations of single and multiple word utterances. Second, we will test the efficacy of a treatment program to improve the ability to activate and maintain activation of semantic and/or phonological representations of single word and multiple word utterances in short-term memory. The efficacy of the treatment will be examined with probes of acquisition and maintenance in a multiple baseline across multiple stimuli design, and with comparisons of pre- and post-test performance on the diagnostic battery and the treatment tasks. This research should have significant benefit to public health. Although language impairments following stroke are often a life-long disability, treatments based on a comprehensive understanding of the language system and its breakdown following brain damage have led to improved language function, even in chronic stages of this disability. This project will examine the efficacy of a diagnostic battery and treatment program for word processing and short-term memory impairments, which invariably co-occur in aphasia. The unique aspect of this program is that it examines and treats word processing deficits in contexts that gradually increase the stress on working memory, thus approximating more closely the conditions in which functional communication occurs. This research should have significant benefit to public health. Although language impairments following stroke are often a life-long disability, treatments based on a comprehensive understanding of the language system and its breakdown following brain damage have led to improved language function, even in chronic stages of this disability.