McCarthy Laura Mary, Kalinyak-Fliszar Michelene, Kohen Francine, Martin Nadine
Department of Communication Sciences, Temple University, Philadelphia, PA, USA.
Aphasiology. 2017;31(5):542-562. doi: 10.1080/02687038.2016.1208803. Epub 2016 Jul 30.
Deep dysphasia is a relatively rare subcategory of aphasia, characterised by word repetition impairment and a profound auditory-verbal short-term memory (STM) limitation. Repetition of words is better than nonwords (lexicality effect) and better for high-image than low-image words (imageability effect). Another related language impairment profile is phonological dysphasia, which includes all of the characteristics of deep dysphasia except for the occurrence of semantic errors in single word repetition. The overlap in symptoms of deep and phonological dysphasia has led to the hypothesis that they share the same root cause, impaired maintenance of activated representation of words, but that they differ in severity of that impairment, with deep dysphasia being more severe.
We report a single-subject multiple baseline, multiple probe treatment study of a person who presented with a pattern of repetition that was consistent with the continuum of deep-phonological dysphasia: imageability and lexicality effects in repetition of single and multiple words and semantic errors in repetition of multiple-word utterances. The aim of this treatment study was to improve access to and repetition of low-imageability words by embedding them in modifier-noun phrases that enhanced their imageability.
METHODS & PROCEDURES: The treatment involved repetition of abstract noun pairs. We created modifier-abstract noun phrases that increased the semantic and syntactic cohesiveness of the words in the pair. For example, the phrases "long distance" and "social exclusion" were developed to improve repetition of the abstract pair "distance-exclusion". The goal of this manipulation was to increase the probability of accessing lexical and semantic representations of abstract words in repetition by enriching their semantic -syntactic context. We predicted that this increase in accessibility would be maintained when the words were repeated as pairs, but without the contextual phrase.
OUTCOMES & RESULTS: Treatment outcomes indicated that increasing the semantic and syntactic cohesiveness of low-imageability and low-frequency words later improved this participant's ability to repeat those words when presented in isolation.
This treatment approach to improving access to abstract word pairs for repetition was successful for our participant with phonological dysphasia. The approach exemplifies the potential value in manipulating linguistic characteristics of stimuli in ways that improve access between phonological and lexical-semantic levels of representation. Additionally, this study demonstrates how principles of a cognitive model of word processing can be used to guide treatment of word processing impairments in aphasia.
深度失语症是失语症中一种相对罕见的亚类，其特征是单词重复受损以及严重的听觉言语短期记忆（STM）受限。单词的重复比非单词更好（词汇性效应），对于高意象性单词比低意象性单词的重复更好（意象性效应）。另一种相关的语言障碍类型是语音性失语症，它包括深度失语症的所有特征，但在单个单词重复中不存在语义错误。深度失语症和语音性失语症症状的重叠导致了这样一种假设，即它们有相同的根本原因，即单词激活表征的维持受损，但它们在该损伤的严重程度上有所不同，深度失语症更严重。
我们报告了一项针对一名患者的单病例多基线、多探针治疗研究，该患者呈现出与深度 - 语音性失语症连续体一致的重复模式：单字和多字重复中的意象性和词汇性效应以及多字话语重复中的语义错误。这项治疗研究的目的是通过将低意象性单词嵌入增强其意象性的修饰语 - 名词短语中来改善对这些单词的提取和重复。
治疗包括重复抽象名词对。我们创建了修饰语 - 抽象名词短语，以增加对中单词的语义和句法连贯性。例如，为了改善抽象对“距离 - 排斥”的重复，创建了短语“长距离”和“社会排斥”。这种操作的目的是通过丰富其语义 - 句法语境来增加在重复中提取抽象单词的词汇和语义表征的可能性。我们预测，当单词成对重复但没有上下文短语时，这种可及性的增加将得以维持。
治疗结果表明，增加低意象性和低频单词的语义和句法连贯性，随后提高了该参与者在孤立呈现这些单词时重复它们的能力。
这种改善对抽象单词对提取以进行重复的治疗方法对我们患有语音性失语症的参与者是成功的。该方法例证了以改善语音和词汇 - 语义表征水平之间的可及性的方式操纵刺激的语言特征的潜在价值。此外，本研究展示了单词加工认知模型的原理如何可用于指导失语症中单词加工障碍的治疗。
