Service de Rééducation Neurologique, Hôpital Swynghedauw, CHRU, Lille, France.
J Neurol. 2010 Jul;257(7):1099-107. doi: 10.1007/s00415-010-5469-8. Epub 2010 Feb 9.
In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe verbal pragmatic difficulties. Frontal stroke also resulted in evident verbal and non-verbal disorders.
在中风患者中，有人认为沟通障碍可能是由于左半球病变的词汇和句法障碍以及右病变的语用问题引起的。然而，我们对患者在二元交流中的行为知之甚少，尤其是在对话中。在这里，我们分析了中风后康复阶段（1-6 个月）参与沟通困难的各种过程，以便确定言语和非言语交流（VC、NVC）障碍的主要机制及其与失语症障碍的关系。共招募了 63 名患者，他们分为 6 组，包括左或右皮质下（L-CSC、R-CSC）或皮质下（L-SC、R-SC）、额叶（Fro）或后颅窝（PF）病变。他们与等效对照组（性别、年龄、教育水平）进行了比较。我们使用了里尔沟通测试，它包括三个部分：沟通参与（问候、注意力、参与）、言语交流（言语理解、言语流出、可理解性、单词产生、句法、言语语用和言语反馈）和非言语交流（理解手势、情感表达、产生手势、语用和反馈）。我们还使用了功能性沟通量表和波士顿诊断失语症检查（BDAE）。L-CSC、R-CSC 和 Fro 患者的参与度下降。言语交流主要在 L-SCS 和 L-SC 组中受到干扰，包括言语语用障碍，在额叶患者中程度较轻。非言语交流主要在 R-CSC 患者中受到影响，特别是语用困难。L-CSC 患者表现出手势产生增加，弥补了失语症。总之，沟通障碍相对复杂，不能用左半球中风的句法和词汇困难以及右半球中风的语用问题来概括。前者还表现出严重的言语语用困难。额叶中风也导致明显的言语和非言语障碍。
