Glize Bertrand, Villain Marie, Richert Laura, Vellay Maeva, de Gabory Isabelle, Mazaux Jean-Michel, Dehail Patrick, Sibon Igor, Laganaro Marina, Joseph Pierre-Alain
Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France -
Neurology, Stroke Unit, INCIA CNRS UMR 5287, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
Eur J Phys Rehabil Med. 2017 Apr;53(2):249-255. doi: 10.23736/S1973-9087.16.04255-6. Epub 2016 Jul 14.
Aphasia recovery remains difficult to predict initially in particular for the most severe cases. The features of impaired verbal communication which are the basis for cognitive-linguistic diagnosis and treatment could be part of prediction of recovery from aphasia.
This study investigated whether some components of language screening in the acute phase of stroke are reliable prognostic factors for language recovery in the post-acute phase.
Monocentric prospective study.
University hospital stroke unit.
Eighty-six patients aged between 21 and 92 years (mean=67.4, SD=15.3) were admitted after a first left hemisphere stroke with aphasia and were consecutively included.
Language assessment was performed in the acute phase and 3 months post-stroke with the LAnguage Screening Test (LAST) and the Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Severe aphasia was defined as ASRS<3. Good recovery was defined as an ASRS≥4. Language scores and other potential predictors of recovery were analysed by comparing groups of patients with good versus poor recovery and as predictors of change with multiple regression approaches.
LAST Total score as well as all the individual items of LAST, NIHSS and ASRS measured in the acute phase significantly differentiated good and poor recovery from aphasia at three months for all aphasic patients and for the most severe cases. In multivariable analyses the repetition score of LAST at the acute phase was significantly associated with the delta of ASRS between the acute phase and 3 months after the stroke reflecting changes in symptom severity.
For patients with initial severe aphasia, word repetition from a language screening task seems to be a more relevant predictor of recovery than initial severity to enrich the prognosis of poststroke aphasia recovery three month after a stroke. These findings show the importance of phonological perception and production as well as speech motor components in the recovery of language. These linguistic aspects of the assessment seem more relevant than severity for prediction in the acute phase.
These findings could improve aphasia management pathway for people with severe aphasia and their families and minimize the evidence-practice gap for speech pathologists.
失语症的恢复情况在一开始就很难预测，尤其是对于最严重的病例。言语交流受损的特征是认知 - 语言诊断和治疗的基础，可能是失语症恢复预测的一部分。
本研究调查了卒中急性期语言筛查的某些组成部分是否是急性后期语言恢复的可靠预后因素。
单中心前瞻性研究。
大学医院卒中单元。
86例年龄在21至92岁之间（平均 = 67.4，标准差 = 15.3）的患者在首次左侧半球卒中伴失语症后入院，并被连续纳入研究。
在急性期和卒中后3个月使用语言筛查测试（LAST）和波士顿诊断失语症检查（BDAE）的失语症严重程度评定量表（ASRS）进行语言评估。严重失语症定义为ASRS < 3。良好恢复定义为ASRS≥4。通过比较恢复良好与恢复不佳的患者组，并使用多元回归方法分析语言得分和其他潜在的恢复预测因素。
对于所有失语症患者以及最严重的病例，急性期测量的LAST总分以及LAST的所有单项、美国国立卫生研究院卒中量表（NIHSS）和ASRS在三个月时显著区分了失语症的良好和不良恢复情况。在多变量分析中，急性期LAST的重复得分与卒中后急性期和3个月之间ASRS的变化量显著相关，反映了症状严重程度的变化。
对于初始严重失语症患者，语言筛查任务中的单词重复似乎比初始严重程度更能预测恢复情况，有助于丰富卒中后三个月失语症恢复的预后。这些发现表明语音感知和产生以及言语运动成分在语言恢复中的重要性。在急性期，这些评估的语言方面对于预测似乎比严重程度更相关。
这些发现可以改善严重失语症患者及其家人的失语症管理途径，并缩小言语病理学家的证据 - 实践差距。
