Tessier Catherine, Weill-Chounlamountry Agnes, Michelot Nadine, Pradat-Diehl Pascale
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation Paris, France, 75013 Paris.
Brain Inj. 2007 Oct;21(11):1165-74. doi: 10.1080/02699050701559186.
Word deafness refers to an inability to understand spoken words despite intact hearing. In a cognitive approach, word deafness could be explained by a deficiency at the lower perceptive level of the auditory process. The impairment of the auditory analysis system would explain a disorder of identification of speech sounds. Only few studies addressed rehabilitation of central auditory processing and have described therapy focused on phoneme discrimination.
To determine whether a specific auditory analysis rehabilitation addressing phoneme discrimination and phoneme recognition may improve oral comprehension and communication.
A single-case experimental design was used in a 65 year-old woman, with word deafness consecutive to a cerebral infarction which occurred 10 months before. Verbal naming, written expression and written comprehension were normal. Verbal comprehension, repetition and phoneme discrimination and recognition were impaired. In terms of cognitive model of auditory processing, the patient showed impairment of the auditory analysis system affecting verbal comprehension. A computerized rehabilitation of auditory analysis system was carried out in two consecutive tasks: phoneme discrimination and phoneme recognition. Errorless learning therapy was used, with a difficulty hierarchy practised from the easier to the most difficult phoneme and systematic visual cues which were progressively delayed and suppressed. This study tested the efficacy and the specificity of this therapy on the addressed tasks (phoneme discrimination and recognition), related tasks (oral comprehension and repetition), independent tasks (recognition of environmental sounds) and daily life (questionnaire).
The phoneme discrimination and recognition impairment was stable over 4 months before therapy. After therapy, phoneme discrimination (p < 0.001) and phoneme recognition (p < 0.0001) were improved. The improvement was specific to verbal sounds recognition, while non-verbal sounds recognition was unchanged. An improvement occurred for repetition (p < 0.05) and oral comprehension (p < 0.01). The communication disability decreased (p < 0.05).
In a case of word deafness, this study demonstrates not only the efficacy of a specific phoneme processing therapy but also its efficacy in the improvement of higher level of cognitive treatment such as oral comprehension and its transfer in daily life. The role of errorless therapy using systematic visual cues and difficulty hierarchy must be underlined.
词聋是指尽管听力完好却无法理解口语单词。从认知角度来看，词聋可以通过听觉过程较低感知水平的缺陷来解释。听觉分析系统的损伤可以解释语音识别障碍。仅有少数研究涉及中枢听觉处理的康复，且描述了专注于音素辨别的治疗方法。
确定针对音素辨别和音素识别的特定听觉分析康复是否可以改善口语理解和交流。
对一名65岁女性采用单病例实验设计，该患者因10个月前发生的脑梗死导致词聋。其言语命名、书面表达和书面理解正常。言语理解、复述以及音素辨别和识别受损。根据听觉处理的认知模型，该患者表现出影响言语理解的听觉分析系统损伤。对听觉分析系统进行了连续两个任务的计算机化康复训练：音素辨别和音素识别。采用无错误学习疗法，按照从较容易到最难的音素练习难度等级，并逐步延迟和消除系统性视觉提示。本研究测试了该疗法在既定任务（音素辨别和识别）、相关任务（口语理解和复述）、独立任务（环境声音识别）以及日常生活（问卷调查）方面的疗效和特异性。
在治疗前的4个月里，音素辨别和识别损伤保持稳定。治疗后，音素辨别（p < 0.001）和音素识别（p < 0.0001）得到改善。这种改善特定于言语声音识别，而非言语声音识别未发生变化。复述（p < 0.05）和口语理解（p < 0.01）有所改善。沟通障碍减轻（p < 0.05）。
在词聋病例中，本研究不仅证明了特定音素处理疗法的疗效，还证明了其在改善更高水平认知治疗（如口语理解）及其在日常生活中的转化方面的疗效。必须强调使用系统性视觉提示和难度等级的无错误疗法的作用。
