Rapp Brenda, Glucroft Brian
Johns Hopkins University, Baltimore, MD, USA.
Aphasiology. 2009 Feb 1;23(2):236-265. doi: 10.1080/02687030801943054.
Spoken and written language difficulties are the predominant symptoms in the progressive neurodegenerative disease referred to as primary progressive aphasia (PPA). There has been very little research on the effectiveness of intervention on spoken language impairments in this context and none directed specifically at progressive written language impairment. AIMS: To examine the effectiveness of behavioural intervention for dysgraphia in a case of primary progressive aphasia. METHODS #ENTITYSTARTX00026; PROCEDURES: We carried out a longitudinal single-case study that allowed us to examine the effectiveness of a non-intensive spell-study-spell intervention procedure. We did so by comparing performance on four sets of words: trained, repeated, homework, and control words at five evaluations: baseline, during intervention, after the intervention, and at 6- and 12-month follow-up. OUTCOMES #ENTITYSTARTX00026; RESULTS: We find that: (1) at the end of the intervention, Trained words show a small but statistically significant improvement relative to baseline and an advantage in accuracy over Control, Homework, and Repeated word sets. (2) All word sets exhibited a decline in accuracy from the end of treatment to the 6-month follow-up evaluation, consistent with the degenerative nature of the illness. Nonetheless, accuracy on Trained words continued to be superior to that of Control words and not statistically different from pre-intervention baseline levels. (3) Repeated testing and practice at home yielded modest numerical advantages relative to Control words; but these differences were, for many comparisons, not statistically significant. (4) At 12 months post-intervention, all words sets had significantly declined relative to pre-intervention baselines and performance on the four sets was comparable. CONCLUSIONS: This investigation documents-for the first time-that behavioural intervention can provide both immediate and short-term benefits for dysgraphia in the context of primary progressive aphasia.
口语和书面语言障碍是被称为原发性进行性失语症（PPA）的进行性神经退行性疾病的主要症状。在这种情况下，针对口语障碍干预效果的研究非常少，且没有专门针对进行性书面语言障碍的研究。
研究行为干预对原发性进行性失语症患者书写障碍的有效性。
我们进行了一项纵向单病例研究，以检验非强化拼写-学习-拼写干预程序的有效性。通过比较四组单词在五次评估（基线、干预期间、干预后以及6个月和12个月随访）中的表现来实现，这四组单词分别是训练词、重复词、家庭作业词和对照词。
我们发现：（1）在干预结束时，训练词相对于基线有小幅但具有统计学意义的改善，并且在准确性上优于对照词、家庭作业词和重复词集。（2）从治疗结束到6个月随访评估，所有词集的准确性都有所下降，这与疾病的退行性本质一致。尽管如此，训练词的准确性仍优于对照词，且与干预前基线水平无统计学差异。（3）与对照词相比，在家中重复测试和练习在数值上有适度优势；但在许多比较中，这些差异无统计学意义。（4）干预后12个月，所有词集相对于干预前基线均显著下降，且四组词集的表现相当。
本研究首次证明，在原发性进行性失语症的背景下，行为干预可为书写障碍带来即时和短期益处。
