Milman Lisa, Anderson Emma, Thatcher Katelyn, Amundson Deborah, Johnson Chance, Jones Morgan, Valles Louie, Willis Dale
Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States.
Utah Education and Telehealth Network, Logan, UT, United States.
Front Neurol. 2020 Nov 19;11:583452. doi: 10.3389/fneur.2020.583452. eCollection 2020.
Language and communication impairments are among the most frequently reported long-term behavioral consequences of brain tumor. Such deficits may persist long after a patient has been discharged from the hospital and can significantly impact return to work, resumption of prior social roles, and interpersonal relations, as well as full engagement in leisure activities. While considerable research has centered on identifying and describing communication impairments in brain tumor survivors, relatively little research has investigated language therapy for this population. This report (1) reviews the literature and describes the language and cognitive-communicative profile of a 35-year-old man 6 years post glioblastoma excision with subsequent chemo- and radiation therapies; (2) presents cognitive-communication outcome data for this individual following an integrated discourse therapy; and (3) assesses treatment feasibility in face-to-face (F2F) and tele-neurorehabilitation (TNR) contexts. A battery of tests and weekly conversation probes were administered to evaluate baseline performance and potential changes associated with F2F and TNR treatment delivery. Integrated Conversation Therapy (ICT) was administered across four alternating (F2F and TNR) treatment blocks over 2 months. ICT is a solution-focused discourse intervention that simultaneously targets word finding, sentence processing, and authentic patient-selected conversational interactions. Although the participant presented with long term-language impairments that were clinically distinct from stroke-associated aphasia, statistically significant post-treatment gains (>2 SEM) were evident following F2F and TNR treatment delivery on standardized measures of apraxia, discourse production, verbal memory, and self-ratings of discourse production, communication, and living with aphasia. While objective measures of treatment effect size (probes of CIU discourse data) were consistent across F2F and TNR delivery models, results of a satisfaction survey indicated a slight but statistically significant participant preference for TNR treatment delivery. This study provides preliminary support for F2F and TNR delivery of ICT discourse intervention for glioblastoma survivors. It also highlights the need for more research specifically dedicated to language therapy for this population.
语言和沟通障碍是脑肿瘤最常被报告的长期行为后果之一。此类缺陷可能在患者出院后长期存在，并会对重返工作岗位、恢复先前的社会角色和人际关系以及充分参与休闲活动产生重大影响。虽然大量研究集中于识别和描述脑肿瘤幸存者的沟通障碍，但针对这一人群的语言治疗研究相对较少。本报告：（1）回顾文献并描述一名35岁男性在胶质母细胞瘤切除术后6年，接受后续化疗和放疗后的语言及认知沟通概况；（2）呈现该个体在接受综合话语治疗后的认知沟通结果数据；（3）评估在面对面（F2F）和远程神经康复（TNR）环境下的治疗可行性。通过一系列测试和每周的对话探针来评估基线表现以及与F2F和TNR治疗实施相关的潜在变化。在2个月内，通过四个交替的（F2F和TNR）治疗模块实施综合对话疗法（ICT）。ICT是一种以解决问题为导向的话语干预，同时针对词汇查找、句子处理以及患者自主选择的真实对话互动。尽管该参与者存在与中风相关性失语在临床上不同的长期语言障碍，但在F2F和TNR治疗实施后，在失用症、话语产出、言语记忆以及话语产出自我评分、沟通和失语生活等标准化测量中，出现了具有统计学意义的治疗后改善（>2个标准误）。虽然治疗效果大小的客观测量（CIU话语数据探针）在F2F和TNR实施模式中是一致的，但满意度调查结果表明参与者对TNR治疗实施略有但具有统计学意义的偏好。本研究为胶质母细胞瘤幸存者的ICT话语干预在F2F和TNR实施方面提供了初步支持。它还强调了针对这一人群专门进行更多语言治疗研究的必要性。
