Marcotte Karine, Laird Laura, Bitan Tali, Meltzer Jed A, Graham Simon J, Leonard Carol, Rochon Elizabeth
Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.
École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada.
Front Neurol. 2018 Apr 9;9:225. doi: 10.3389/fneur.2018.00225. eCollection 2018.
Despite the growing evidence regarding the importance of intensity and dose in aphasia therapy, few well-controlled studies contrasting the effects of intensive and non-intensive treatment have been conducted to date. Phonological components analysis (PCA) treatment for anomia has been associated with improvements in some patients with chronic aphasia; however, the effect of treatment intensity has not yet been studied with PCA. Thus, the aim of the present study was to identify the effect of intensity on neural processing associated with word retrieval abilities after PCA treatment. We used functional magnetic resonance imaging to examine therapy-induced changes in activation during an overt naming task in two patients who suffered from a stroke in the left middle cerebral artery territory. P1 received intensive PCA treatment whereas P2 received the standard, non-intensive, PCA treatment. Behavioral results indicate that both standard and intensive conditions yielded improved naming performance with treated nouns, but the changes were only significant for the patient who received the intensive treatment. The improvements were found to be long lasting as both patients maintained improved naming at 2-months follow-ups. The associated neuroimaging data indicate that the two treatment conditions were associated with different neural activation changes. The patient who received the standard PCA showed significant increase in activation with treatment in the right anterior cingulate, as well as extensive areas in bilateral posterior and lateral cortices. By contrast, the patient who received intensive PCA showed more decreases in activation following the treatment. Unexpectedly, this patient showed subcortical increase in activation, specifically in the right caudate nucleus. We speculate that the recruitment of the caudate nucleus and the anterior cingulate in these patients reflects the need to suppress errors to improve naming. Thus, both short-term intensive and standard, non-intensive, PCA treatment can improve word retrieval in chronic aphasia, but neuroimaging data suggest that improved naming is associated with different neural activation patterns in the two treatment conditions.
尽管越来越多的证据表明强度和剂量在失语症治疗中很重要，但迄今为止，很少有对照良好的研究对比强化治疗和非强化治疗的效果。针对命名性失语的语音成分分析（PCA）治疗已使一些慢性失语症患者有所改善；然而，尚未对PCA治疗强度的效果进行研究。因此，本研究的目的是确定强度对PCA治疗后与单词检索能力相关的神经加工的影响。我们使用功能磁共振成像来检查两名左大脑中动脉区域中风患者在公开命名任务期间治疗引起的激活变化。P1接受了强化PCA治疗，而P2接受了标准的、非强化的PCA治疗。行为结果表明，标准治疗和强化治疗条件下，治疗过的名词的命名表现均有所改善，但这些变化仅在接受强化治疗的患者中显著。发现这些改善是持久的，因为两名患者在2个月的随访中命名能力均保持改善。相关的神经影像数据表明，两种治疗条件与不同的神经激活变化相关。接受标准PCA治疗的患者在右侧前扣带回以及双侧后部和外侧皮质的广泛区域中，治疗后激活显著增加。相比之下，接受强化PCA治疗的患者治疗后激活减少更多。出乎意料的是，该患者的皮质下激活增加，特别是在右侧尾状核。我们推测，这些患者中尾状核和前扣带回的募集反映了抑制错误以改善命名的需求。因此，短期强化治疗和标准的非强化PCA治疗均可改善慢性失语症患者的单词检索能力，但神经影像数据表明，两种治疗条件下命名能力的改善与不同的神经激活模式相关。
