Jungblut Monika, Mais Christiane, Huber Walter, Binkofski Ferdinand Ch, Schüppen André
Interdisciplinary Institute for Music- and Speech-Therapy, Duisburg, Germany.
Interdisciplinary Institute for Music- and Speech-Therapy, Duisburg, Germany; Aphasia Center North Rhine Westphalia, Essen, Germany.
Cortex. 2020 Nov;132:147-165. doi: 10.1016/j.cortex.2020.08.009. Epub 2020 Sep 4.
Over a period of five years, three severely impaired chronic non-fluent aphasia patients with concomitant apraxia of speech (AOS) received annual treatment periods of specific rhythmic-melodic voice training SIPARI. This therapy concept focusses on improving planning, programming, and sequencing of speech movements emphasizing specifically the training of cognitive capabilities such as executive functions. Behavioral and neural data were assessed at the start of the therapy and continuously after each treatment period. As previously reported, a first major finding was that after the first treatment period, significant improvements in language and speech motor performance were measured going hand in hand with significant additional peri-lesional activation in all patients particularly in the posterior part of the left superior temporal gyrus. This activation pattern was continuously confirmed by each subsequent scan. However, assessments after the third treatment period yielded additional significant activations in dorsolateral prefrontal cortex regions, namely in the left middle and superior frontal gyri, and anterior cingulate gyrus resulting in a further statistically significant increase in speech profile level, an overall and clinically relevant measure of the severity of aphasia. On the basis of our results, we assume that even in long-term rehabilitation of severely impaired non-fluent aphasia patients the applied treatment may support coactivation with dorsolateral prefrontal regions, suggested to be particularly involved in cognitive processing. This left-lateralized dorsolateral prefrontal-parietal network is supposed to be engaged in domain-general aspects of active phonological memory. To the best of our knowledge, no comparable studies are available as yet. Therefore, we hope that our study may serve to attract more attention for the late stages of long-term rehabilitation, not at least as a challenge for therapists and researchers alike.
在五年的时间里，三名患有严重慢性非流畅性失语症且伴有言语失用症（AOS）的患者接受了为期一年的特定节奏 - 旋律语音训练SIPARI。这种治疗理念侧重于改善言语运动的计划、编程和序列安排，特别强调对诸如执行功能等认知能力的训练。在治疗开始时以及每个治疗期结束后持续评估行为和神经数据。如先前报道，第一个主要发现是在第一个治疗期后，测量到语言和言语运动表现有显著改善，同时所有患者特别是左颞上回后部出现显著的额外病灶周围激活。这种激活模式在随后的每次扫描中都得到持续证实。然而，在第三个治疗期后的评估中，背外侧前额叶皮层区域出现了额外的显著激活，即在左侧额中回和额上回以及前扣带回，这导致言语概况水平进一步出现统计学上的显著增加，言语概况水平是失语症严重程度的一个总体且具有临床相关性的指标。基于我们的研究结果，我们认为即使在严重受损的非流畅性失语症患者的长期康复中，所应用的治疗也可能支持与背外侧前额叶区域的共同激活，这些区域被认为特别参与认知加工。这种左侧化的背外侧前额叶 - 顶叶网络被认为参与了主动语音记忆的领域通用方面。据我们所知，目前尚无类似研究。因此，我们希望我们的研究能够吸引更多人关注长期康复的后期阶段，至少对治疗师和研究人员来说是一个挑战。
