Stockbridge Melissa D, Berube Shauna, Goldberg Emily, Suarez Adrian, Mace Rachel, Ubellacker Delaney, Hillis Argye E
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
Aphasiology. 2021;35(3):357-371. doi: 10.1080/02687038.2019.1693026. Epub 2019 Dec 4.
Characterizing productive language deficits following lesions to the right (RH) or left hemispheres (LH) is valuable in identifying appropriate therapeutic goals. While damage to the LH classically is associated with deficits in language, RH lesions also result in changed communication beyond prosody due to cognitive-linguistic effects. Cohesion, reference to introduced content across sentences within discourse, relies on a listener's clear and unambiguous understanding that a reference has occurred. To date, we are not aware of any prior work that has compared patterns of cohesive strategy between RH and LH lesioned individuals with cohesion deficits.
The purpose of the present study is to determine whether individuals with communication deficits following RH and LH lesions differ in the inclusion and clarity of cohesive markers.
METHODS & PROCEDURES: Seventy-six RH samples and 145 LH samples were used for comparison of cohesion performance in a picture description task. Cohesive ties were assessed following the protocol outlined in Liles and Coelho (1998). It was hypothesized that individuals with LH lesions would present a different pattern of cohesion behaviour than RH lesioned individuals when considered both acutely and chronically.
OUTCOMES & RESULTS: Overall, samples from LH and RH groups did not differ in word counts or cohesive marker usage. However, the patterns of markers they chose to employ were different. LH samples used conjunctions and personal pronouns more frequently and used lexical cohesive markers less frequently than RH samples. Acutely, patterns of cohesive marker use between LH and RH samples were more similar. Chronically, LH samples contained more personal pronouns and the differences in lexical cohesive markers remained unchanged. When cohesion was unsuccessful, LH and RH damage were associated with different patterns of error. LH samples tended to omit information needed to clarify the intended referent, resulting in incomplete cohesion errors. RH samples tended to sustain breakdowns in cohesion from sentence to sentence, not resolving incorrectly chosen pronouns or ambiguities left in their samples.
LH and RH lesions resulted in differing patterns of chosen cohesive markers and errors when cohesion was unsuccessful. This was particularly true in lexical cohesion, which has been far less studied than closed-class cohesive markers like referential pronouns. It was also noted that cohesive behavior did not appear to "recover" for either group, suggesting spontaneous recovery is minimal and present strategies for language therapy may not effectively address this linguistic function.
明确右侧（RH）或左侧大脑半球（LH）受损后的语言产出缺陷，对于确定合适的治疗目标很有价值。虽然传统上认为LH受损与语言缺陷有关，但由于认知 - 语言效应，RH损伤也会导致韵律之外的交流变化。衔接，即在语篇中跨句子提及引入的内容，依赖于听众对已发生指代的清晰明确理解。迄今为止，我们尚未发现有任何先前的研究比较过RH和LH受损且存在衔接缺陷的个体之间的衔接策略模式。
本研究的目的是确定RH和LH损伤后有交流缺陷的个体在衔接标记的包含和清晰度方面是否存在差异。
76个RH样本和145个LH样本用于在图片描述任务中比较衔接表现。按照Liles和Coelho（1998）中概述的方案评估衔接关系。假设在急性和慢性情况下，LH损伤个体与RH损伤个体相比会呈现出不同的衔接行为模式。
总体而言，LH组和RH组样本在单词数量或衔接标记使用上没有差异。然而，他们选择使用的标记模式不同。LH样本比RH样本更频繁地使用连词和人称代词，而较少使用词汇衔接标记。在急性情况下，LH和RH样本之间的衔接标记使用模式更相似。在慢性情况下，LH样本包含更多人称代词，词汇衔接标记的差异保持不变。当衔接不成功时，LH和RH损伤与不同的错误模式相关。LH样本倾向于省略澄清预期指代所需的信息，导致衔接不完整错误。RH样本倾向于在句子之间维持衔接中断，不解决错误选择的代词或样本中留下的歧义。
LH和RH损伤在衔接不成功时导致了不同的所选衔接标记模式和错误。在词汇衔接方面尤其如此，词汇衔接的研究远少于像指示代词这样的封闭类衔接标记。还注意到，两组的衔接行为似乎都没有“恢复”，这表明自发恢复极小，当前的语言治疗策略可能无法有效解决这种语言功能问题。
