Peach Richard K, Beck Katherine M, Gorman Michelle, Fisher Christine
Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL.
J Speech Lang Hear Res. 2019 Aug 15;62(8):2785-2811. doi: 10.1044/2019_JSLHR-L-18-0504. Epub 2019 Jul 25.
Purpose This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 (Sohlberg & Mateer, 2010). Method Four individuals with mild-moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes. Results Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery-Revised Aphasia Quotients (Kertesz, 2007) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT. Conclusions The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation. Supplemental Material https://doi.org/10.23641/asha.8986427.
目的 本研究旨在探讨两种不同方法（一种是特定领域方法，另一种是一般领域方法）对中风后失语症患者语言和注意力康复的比较效果。特定领域治疗包括特定语言注意力治疗（L-SAT），一般领域治疗包括使用《注意力训练程序-3》（Sohlberg & Mateer，2010）中包含的计算机化练习进行直接注意力训练（DAT）。方法 四名轻度至中度失语症患者参与了本研究。采用随机对照交叉单受试者设计来评估本研究中给予的两种治疗的效果。根据每个项目中参与者的任务表现、标准化语言和注意力测量、功能能力测试以及患者报告的结果来评估治疗结果。结果 视觉比较显示，L-SAT后有线性改善，DAT后有可变模式。在13项L-SAT任务中的9项任务中，综合效应量具有统计学意义。L-SAT后治疗后变化的加权标准化效应量范围从小到 大，但有1项任务除外。DAT后的平均组增益为5%。《西方失语症成套测验修订版》失语商数（Kertesz，2007）显示，4名参与者中有3名在L-SAT后有可靠的改善，而在DAT后只有1名参与者有可靠的改善。L-SAT后功能性语言的改善幅度明显大于DAT。在选定的《日常注意力测试》（Robertson、Ward、Ridgeway和Nimmo-Smith，1994）子测试中，2名参与者在L-SAT后以及1名参与者在DAT后，《日常注意力测试》的表现有显著改善。与DAT相比，治疗后患者报告的沟通和注意力结果更倾向于L-SAT。结论 结果支持这样一种观点，即注意力是以特定于特定任务的方式分配的，而不是作为一种等效地分配给所有处理任务的一般资源。对于因注意力障碍导致的语言缺陷，特定领域治疗似乎是失语症康复的一种合适（如果不是更可取）的方法。补充材料 https://doi.org/10.23641/asha.8986427。
