Tompkins Connie A, Scharp Victoria L, Meigh Kimberly, Blake Margaret Lehman, Wambaugh Julie
Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA.
Aphasiology. 2012 May 1;26(5):689-708. doi: 10.1080/02687038.2012.676869.
This manuscript reports generalization effects of Contextual Constraint Treatment for an adult with right hemisphere brain damage (RHD). Contextual Constraint Treatment is designed to stimulate inefficient language comprehension processes implicitly, by providing linguistic context to prime, or constrain, the intended interpretations of treatment stimuli. The study participant had a coarse coding deficit, defined as delayed mental activation of particularly distant semantic features of words (e.g., rotten as a feature of "apple"). Treatment effects were expected to generalize to auditory comprehension of narrative discourse, and perhaps to figurative language interpretation, because coarse coding has been hypothesized and/or demonstrated to support these abilities. AIMS: This treatment study aimed to induce generalization of Contextual Constraint Treatment in an adult with RHD with inefficient coarse coding. METHODS #ENTITYSTARTX00026; PROCEDURES: The participant in this study was a 75 year old man with RHD and a coarse coding deficit. A single subject experimental design across behaviors (stimulus lists) was used to document performance in baseline, treatment, and follow-up phases. Treatment consisted of providing brief, spoken context sentences to prestimulate, or constrain, intended interpretations of stimulus items. The participant made no explicit associations or metalinguistic judgments about the constraint sentences or stimulus words; rather, these contexts served only as implicit primes. Probe tasks were adapted from prior work on coarse coding in RHD. The dependent measure was the percentage of responses that met predetermined response time criteria. There were two levels of contextual constraint, Strong and Moderate. Treatment for each item began with the provision of the Strong constraint context, to minimize the production or reinforcement of erroneous or exceedingly slow responses. Generalization was assessed to a well-standardized measure of narrative discourse comprehension and to several metalinguistic tasks of figurative language interpretation. OUTCOMES #ENTITYSTARTX00026; RESULTS: Treatment-contingent gains, associated with respectable effect sizes, were evident after a brief period of treatment on one stimulus list. Generalization occurred to untrained items, suggesting that the treatment was facilitating the underlying coarse coding process. Most importantly, generalization was evident to narrative comprehension performance, for both overall accuracy and accuracy answering questions about implied information, and all of these gains maintained through three follow-up sessions. CONCLUSIONS: Though the results are still preliminary, this single-subject experimental design documents the potential for meaningful gains from a novel treatment that implicitly targets an underlying language comprehension process in an adult with RHD.
本手稿报告了情境约束疗法对一名右半球脑损伤（RHD）成人患者的泛化效应。情境约束疗法旨在通过提供语言情境来启动或限制治疗刺激的预期解释，从而隐性地刺激低效的语言理解过程。研究参与者存在粗略编码缺陷，即对单词特别遥远的语义特征（如“苹果”的“腐烂”特征）的心理激活延迟。由于已经假设和/或证明粗略编码支持这些能力，因此预期治疗效果会泛化到叙事话语的听觉理解，甚至可能泛化到比喻性语言解释。目的：本治疗研究旨在诱导情境约束疗法在一名存在低效粗略编码的RHD成人患者中实现泛化。方法和程序：本研究的参与者是一名75岁的男性，患有RHD且存在粗略编码缺陷。采用跨行为（刺激列表）的单受试者实验设计来记录基线、治疗和随访阶段的表现。治疗包括提供简短的口语情境句子，以预先刺激或限制刺激项目的预期解释。参与者对约束句子或刺激词没有明确的联想或元语言判断；相反，这些情境仅作为隐性启动因素。探测任务改编自先前关于RHD粗略编码的研究。因变量是符合预定反应时间标准的反应百分比。有两种情境约束水平，强约束和中等约束。每个项目的治疗从提供强约束情境开始，以尽量减少错误或极其缓慢反应的产生或强化。对叙事话语理解的一项标准化测量以及几项比喻性语言解释的元语言任务进行了泛化评估。结果：在对一个刺激列表进行短暂治疗后，与可观效应量相关的治疗相关增益明显。泛化发生在未训练的项目上，表明治疗促进了潜在的粗略编码过程。最重要的是，叙事理解表现出现了泛化，无论是总体准确性还是回答关于隐含信息问题的准确性，并且所有这些增益在三次随访中都得以维持。结论：尽管结果仍属初步，但这种单受试者实验设计证明了一种新疗法在一名患有RHD的成人患者中针对潜在语言理解过程隐性治疗可能获得有意义收益的潜力。
