Doesborgh Suzanne J C, van de Sandt-Koenderman Mieke W E, Dippel Diederik W J, van Harskamp Frans, Koudstaal Peter J, Visch-Brink Evy G
Erasmus MC, Department of Neurology and Neuropsychology, Rotterdam, The Netherlands.
Stroke. 2004 Jan;35(1):141-6. doi: 10.1161/01.STR.0000105460.52928.A6. Epub 2003 Dec 4.
Semantic deficits, deficits in word meaning, have a large impact on aphasic patients' verbal communication. We investigated the effects of semantic treatment on verbal communication in a randomized controlled trial.
Fifty-eight patients with a combined semantic and phonological deficit were randomized to receive either semantic treatment or the control treatment focused on word sound (phonology). Fifty-five patients completed pretreatment and posttreatment assessment of verbal communication (Amsterdam Nijmegen Everyday Language Test [ANELT]). In an on-treatment analysis (n=46), treatment-specific effects on semantic and phonological measures were explored.
Both groups improved on the ANELT, with no difference between groups in overall score (difference, -1.1; 95% confidence interval [CI], -5.3 to 3.1). After semantic treatment, patients improved on a semantic measure (mean improvement, 2.9; 95% CI, 1.2 to 4.6), whereas after phonological treatment, patients improved on phonological measures (mean improvement, 3.0; 95% CI, 1.4 to 4.7, and 3.0; 95% CI, 1.2 to 4.7).
No differences in primary outcome were noted between the 2 treatments. Our findings challenge the current notion that semantic treatment is more effective than phonological treatment for patients with a combined semantic and phonological deficit. The selective gains on the semantic and phonological measures suggest that improved verbal communication was achieved in a different way for each treatment group.
语义缺陷，即词义方面的缺陷，对失语症患者的言语交流有很大影响。我们在一项随机对照试验中研究了语义治疗对言语交流的影响。
58名存在语义和语音综合缺陷的患者被随机分组，分别接受语义治疗或侧重于单词发音（语音学）的对照治疗。55名患者完成了言语交流的治疗前和治疗后评估（阿姆斯特丹奈梅亨日常语言测试[ANELT]）。在治疗期分析（n = 46）中，探讨了治疗对语义和语音指标的特定影响。
两组在ANELT上均有改善，两组总体得分无差异（差异为-1.1；95%置信区间[CI]为-5.3至3.1）。语义治疗后，患者在语义指标上有所改善（平均改善2.9；95%CI为1.2至4.6），而语音治疗后，患者在语音指标上有所改善（平均改善3.0；95%CI为1.4至4.7，以及3.0；95%CI为1.2至4.7）。
两种治疗方法在主要结局上未发现差异。我们的研究结果挑战了当前的观念，即对于存在语义和语音综合缺陷的患者，语义治疗比语音治疗更有效。在语义和语音指标上的选择性改善表明，每个治疗组以不同方式实现了言语交流的改善。
