Department of Linguistics, University of Potsdam, Germany.
Speech and Hearing Sciences, University College Cork, Ireland.
J Speech Lang Hear Res. 2019 Jun 19;62(6):1979-2001. doi: 10.1044/2018_JSLHR-L-18-0057. Epub 2019 May 21.
Purpose The aims of this systematic review are to provide a critical overview of short-term memory (STM) and working memory (WM) treatments in stroke aphasia and to systematically evaluate the internal and external validity of STM/WM treatments. Method A systematic search was conducted in February 2014 and then updated in December 2016 using 13 electronic databases. We provided descriptive characteristics of the included studies and assessed their methodological quality using the Risk of Bias in N-of-1 Trials quantitative scale ( Tate et al., 2015 ), which was completed by 2 independent raters. Results The systematic search and inclusion/exclusion procedure yielded 17 single-case or case-series studies with 37 participants for inclusion. Nine studies targeted auditory STM consisting of repetition and/or recognition tasks, whereas 8 targeted attention and WM, such as attention process training including n-back tasks with shapes and clock faces as well as mental math tasks. In terms of their methodological quality, quality scores on the Risk of Bias in N-of-1 Trials scale ranged from 4 to 17 ( M = 9.5) on a 0-30 scale, indicating a high risk of bias in the reviewed studies. Effects of treatment were most frequently assessed on STM, WM, and spoken language comprehension. Transfer effects on communication and memory in activities of daily living were tested in only 5 studies. Conclusions Methodological limitations of the reviewed studies make it difficult, at present, to draw firm conclusions about the effects of STM/WM treatments in poststroke aphasia. Further studies with more rigorous methodology and stronger experimental control are needed to determine the beneficial effects of this type of intervention. To understand the underlying mechanisms of STM/WM treatment effects and how they relate to language functioning, a careful choice of outcome measures and specific hypotheses about potential improvements on these measures are required. Future studies need to include outcome measures of memory functioning in everyday life and psychosocial functioning more generally to demonstrate the ecological validity of STM and WM treatments.
目的 本系统评价旨在对脑卒中后失语症的短期记忆 (STM) 和工作记忆 (WM) 治疗进行批判性综述，并系统评估 STM/WM 治疗的内部和外部有效性。
方法 于 2014 年 2 月进行了系统检索，然后于 2016 年 12 月更新，使用了 13 个电子数据库。我们提供了纳入研究的描述性特征，并使用 Tate 等人 (2015 年) 提出的 1-被试实验风险偏倚定量量表 (Risk of Bias in N-of-1 Trials quantitative scale) 评估了其方法学质量，该量表由 2 名独立评分者完成。
结果 系统检索和纳入/排除程序共纳入了 17 项包含 37 名参与者的单病例或病例系列研究。9 项研究的目标是听觉 STM，包括重复和/或识别任务，而 8 项研究的目标是注意力和 WM，如注意力处理训练，包括形状和钟面的 n 回任务以及心算任务。就其方法学质量而言，1-被试实验风险偏倚定量量表的偏倚风险评分范围为 0-30 分制的 4-17 分 (M = 9.5)，表明所审查研究的偏倚风险较高。治疗效果最常评估 STM、WM 和口语理解。仅有 5 项研究测试了日常生活活动中的沟通和记忆的转移效应。
结论 由于所审查研究的方法学局限性，目前难以对脑卒中后失语症的 STM/WM 治疗效果得出确切结论。需要进一步进行更严格的方法学和更强的实验控制的研究，以确定这种干预类型的有益效果。为了了解 STM/WM 治疗效果的潜在机制以及它们与语言功能的关系，需要仔细选择结果测量指标，并对这些测量指标的潜在改善提出具体假设。未来的研究需要在日常生活中包括记忆功能和更广泛的心理社会功能的结果测量指标，以证明 STM 和 WM 治疗的生态有效性。
