van de Sandt-Koenderman Wilhelmina M E, van Harskamp Frans, Duivenvoorden Hugo J, Remerie Sylvia C, van der Voort-Klees Yvonne A, Wielaert Sandra M, Ribbers Gerard M, Visch-Brink Evy G
Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
Int J Rehabil Res. 2008 Dec;31(4):314-20. doi: 10.1097/MRR.0b013e3282fc0f23.
Treatment success in aphasia is influenced by various factors. Clinical decisions, including patient selection and decisions on frequency and content, are often guided by a clinician's implicit opinions. The Multi-axial Aphasia System (MAAS) was developed to structure linguistic, somatic, neuropsychological, psychosocial and socio-economic information on five separate axes, enabling an explicit and interdisciplinary process of clinical decision-making. The objectives of this study were to investigate the potentialities of MAAS in predicting the outcome of cognitive-linguistic treatment. A group of 58 aphasic patients were investigated prospectively. All received cognitive-linguistic treatment during a randomized, controlled study on the efficacy of lexical semantic treatment. An interdisciplinary aphasia team rated the pretreatment MAAS profiles of all patients. The team was blinded for treatment allocation and outcome. A multiple linear regression analysis was performed with the posttreatment verbal communication score as the variable to be predicted and the overall MAAS rating, age and type of treatment as predictor variables. In a second multiple regression analysis, the ratings for each of the five MAAS axes were used as candidate predictors. The team's overall rating contributed significantly to the prediction of verbal communicative ability after linguistic treatment. Of the five MAAS axes, the neuropsychological axis contributed to the prediction. An interdisciplinary approach to aphasia assessment may contribute to realistic goal setting in aphasia rehabilitation. The results of this study stress the importance of neuropsychological assessment of aphasic patients before treatment.
失语症治疗的成功受到多种因素的影响。临床决策，包括患者选择以及治疗频率和内容的决策，往往受临床医生的隐性观点指导。多轴失语症系统（MAAS）旨在将语言、躯体、神经心理、心理社会和社会经济信息在五个独立轴上进行结构化整理，从而实现明确且跨学科的临床决策过程。本研究的目的是调查MAAS在预测认知语言治疗结果方面的潜力。对一组58名失语症患者进行了前瞻性研究。在一项关于词汇语义治疗疗效的随机对照研究中，所有患者均接受了认知语言治疗。一个跨学科失语症团队对所有患者治疗前的MAAS概况进行了评分。该团队对治疗分配和结果不知情。以治疗后的言语交流分数作为待预测变量，以MAAS总体评分、年龄和治疗类型作为预测变量进行多元线性回归分析。在第二次多元回归分析中，将MAAS五个轴各自的评分用作候选预测变量。该团队的总体评分对语言治疗后言语交际能力的预测有显著贡献。在MAAS的五个轴中，神经心理轴对预测有贡献。跨学科的失语症评估方法可能有助于失语症康复中设定切实可行的目标。本研究结果强调了治疗前对失语症患者进行神经心理评估的重要性。
