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Aphasia overview失语症指南(下)

(2011-04-09 23:58:44)
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感谢浙江省人医康复科闻万顺医生提供并邀请我做浙江省康复医学会论坛语言吞咽版块版主,诚蒙兄抬看的起,不胜荣幸!希望能做好、、、

 

[quote]Aphasia overview
失语症指南(下)
翻译   李琳1  审核  叶祥明1
For many years, aphasia therapies were based on early neuroanatomic concepts developed in the 19th century.
多年来,失语治疗一直基于19世纪初开发的神经解剖学概念。
“This part of the brain does that,” in other words.
换句话说,“大脑功能区的划分”。
Our understanding of the brain and of language has led to a less structure-driven approach.
我们对大脑和语言的理解,已经不再是结构决定功能的模式了。
Both hemispheres of the brain do contribute to language function. Although the left-hemisphere seems to be the primary regulator of language, researchers now recognize that the right-hemisphere also contributes to language production.
双侧大脑半球都有助于语言功能。虽然左脑似乎是语言的主要监管机构,现在研究人员认识到,右半球也有助于语言的产生。
The brains of some patients have demonstrated surprising plasticity in language recovery after strokes (which is the good news) but seem to involve a variety of neural mechanisms which have yet to be clearly identified (which is the bad news.) 35 Reorganization of the speech networks may possibly occur for more than one year after the stroke. 36
一些病人的大脑在中风后语言康复过程中表现出惊人的可塑性(好消息),但似乎涉及很多未明的神经机制(坏消息)。卒中发生1年多以后可能还会发生语言网络的重组。
However, “…results stress the inferior role of the right hemisphere language-related network for recovery from post-stroke aphasia; i.e., it contributes to improvement to some extent, if the more important left hemispheric areas are destroyed….” 37
然而,“...研究结果显示右半球语言网络在卒中后失语恢复过程中发挥次要作用。也就是说,如果更重要的左侧半球被破坏...言语功能可以得到一定程度的恢复。
We are still learning about the brain mechanisms for human language, considered the most complex of human cognitive functions. Language uses a large amount of the cerebral cortex, but does not map directly to regions in a straightforward fashion.
我们仍然在学习语言(它被认为是人类最复杂的认知功能)产生的大脑机制。语言产生需要大量大脑皮层的参与,无法定位特定功能区。
Brain imaging now points to three neural correlates of language: widely distributed; regional; and highly localized.38
脑影像学检查显示言语相关神经中枢在脑内的分布形式包括:散在分布、区域性和高度集中分布。
Thus we know that language is not confined to one or two discrete areas but aren’t yet able to capitalize on this knowledge.
我们已知语言功能并不取决于一两个独立区域,但尚未能够利用已知知识。
As imaging techniques continue to improve, the diagnostic and treatment value of brain imaging will certainly increase the chances of reasonable recovery of language after strokes. At the moment, however, it is not clear exactly what we need to know from imaging studies that would improve the outcome of speech and language, or even pharmacotherapeutic interventions.
随着成像技术不断提高,脑成像的诊断和治疗价值肯定有助于中风后言语功能障碍的合理化治疗。但目前,目前我们还不清楚自己要从影像研究中知道什么。影像学研究将提高言语治疗,甚至药物治疗的疗效。
An additional challenge is the question of how available brain imaging would be for the average patient. Until there is a clear connection demonstrated for how the results of brain imaging could enhance aphasia therapy, it is unlikely that insurance companies or Medicare would reimburse for functional MRI’s or other scans.
我们面临的另一个问题是如何得到普通病人的脑成像资料。除非有确定证据证明脑成像结果有利于失语症治疗,否则,保险公司或医疗保险将不可能为功能磁共振或其他扫描买单。
Summary of current treatment approaches for aphasia目前失语症治疗方法概述
“Until World War I, the majority of techniques used in aphasia rehabilitation were ‘borrowed’ from the field of childhood education. The years following World War I witnessed an increase in aphasia treatment studies because of the large numbers of patients with penetration cranial injuries returning from the war.” 39
“第一次世界大战以前,大部分失语症康复技术参照儿童教育。第一次世界大战后几年,由于大量颅脑外伤患者从战场归来,失语症治疗研究明显增多。”
Research in the past fifteen years has largely focused on resolving the question of whether therapy can produce measurable gains over that observed in spontaneous language recovery.
过去15年的研究主要集中于解决这样一个问题----失语治疗是否比自然恢复获益更多。
“Although different aphasia therapies are usually considered to be either effective or ineffective in particular settings, they have not generally been thought of as having the potential for harm. Thus, it is perfectly reasonable to try one approach, and if it doesn’t work, to try another, without ever facing a risk of detriment to the patient (other than prolonging recovery.) This may not be correct. If aphasia treatments have the potential to change the brain, then they have the potential to change it both for better or for worse.” 40
虽然不同的失语症治疗方法在特定的条件下常常被认为是有效或无效的,但却未发现其有害。因此,我们完全可以先尝试一个方法,如果无效,则选择另一个,完全不用担心会给病人带来危害(除外延长恢复时间)。当然,这样这种做可能不对。如果失语症治疗可以改变大脑,那么他们可能使之变好也可能使之变坏。
Stimulus-response approach (most common)刺激---反应法
“First the aphasic deficit is identified and, then, repetitive drill through several modalities (e.g., reading or repetition) is encouraged. An endless array of sophisticated modifications of this traditional approach has been developed.” 41
“首先,诊断为失语症,然后,鼓励患者进行反复练习(如阅读或复述)。由这种传统疗法衍生了大量类似治疗方法。“
A promising modification of the stimulus-response model is Melodic Intonation Therapy. “Based on the assumption that the stress, intonation, and melodic patterns of language output are controlled by the right hemisphere and, thus, are available for use in the individual with left hemisphere damage.” 42
一个很有前景的刺激反应模型衍生的治疗方法是旋律吟诵法。 “因为人们认为重音,语调和旋律由右半球控制,所以,左脑损伤的患者功能不受影响。”
MIT “is a hierarchically structured program that is divided into three levels….multisyllabic works and short, high-probability phrases are musically intoned….then, longer more phonologically complex sentences are intoned…and finally spoken normally.” 43
MIT是一个分为3层的递阶程序。首先,吟诵多音节词、短单词和重复出现的短语...;其次,诵读再更复杂的句子...;最后发言趋于正常。”
Not all patients are suitable candidates for MIT.
并不是所有患者都适合MIT法。
The drill basis for speech therapy is widely used. Doubtless, even with newer therapies, it will be found that repetition of some kind will continue to be important component of therapy.
许多言语治疗的基础都是反复训练。毋庸置疑,即使是新方法,某种形式的重复也是不可或缺的要素。
Psycholinguistic approach精神语言疗法
Combining both the psychologist’s and linguist’s approaches to the study of language as it is learned and used by people, psycholinguistics has proven more helpful with anomia and agrammaticism than aphasia. Psycholinguists “ask questions about what information is in the ‘mental dictionary’ and how it is organized so it can be accessed in ‘real time’ (i.e., while we are listening or speaking), and used to assemble multi-word phrases and sentence structure into coherent discourse.” 44
精神语言疗法,兼备心理学家的和语言学家的语言研究方法,对命名性失语和语法障碍的疗效优于失语症。心理语言学家感兴趣的是精神领域有哪些信息,它们是怎样组织以便'实时'利用的(即,我们听或说),它们如何将短语和句子汇编成连贯的话语。
“The premise underlying this approach is that a specific aphasic sign of symptom may be the surface clinical manifestation of different underlying deficits in within the cognitive structure of language. Only by uncovering the precise underlying psycholinguistic deficit can therapy be properly targeted.” 45
“这种方法的基本前提是,某一失语症状可能是潜在不同语言认知结构障碍的临床表现。只有找到准确的潜在精神语言障碍,治疗才能有的放矢。
Cognitive neurorehabilitation认知神经康复
Treating neurobehavioral deficits such as inattention and memory loss is at the core of cognitive neurorehabilitation. Some researchers are finding that treating perseveration or attentional dysfunctions can help improve language function. 46
认知神经康复的核心是治疗神经行为异常,如注意力不集中和记忆丧失。一些研究人员发现,治疗持续言语或注意力障碍有助于改善语言功能。
The neuropsychological exam can uncover many problems with cognition: such as level of self-awareness; attention/concentration difficulties; visual and perceptual abilities; memory and learning abilities; planning and organizing abilities; and perseveration.47
神经心理测试可以发现许多认知问题:例如自知水平,注意/精力集中困难,视觉和感知能力,记忆和学习能力,组织规划能力和持续言语。
Each of these deficits may require a different set of tasks or exercises, which cognitive neuroscientists are developing.
每项功能障碍都可能需要认知神经学家设定不同任务、练习。
Brain imaging studies support the involvement of “subcortical and prefrontal areas associated with various aspects of arousal, attention, and sequenced planning of response seem particularly important in language and speech.” 48
脑成像研究提示“与觉醒、注意力、顺序反应有关的皮层下和额前区在言语产生中尤为重要。”
Computer aided therapy电脑辅助治疗
“Technology has also entered the scenario of aphasia therapy, with computers and mechanical devices that can potentially help aphasic persons to communicate more efficiently. The development of various programs for computerized language training opened new expectation on aphasia treatment. These programs were considered either as a way for improving cost effectiveness in aphasia treatment, or as a potential tool for developing new therapeutic approaches.
“电脑和机械设备,可帮助失语症患者更有效地交流,这些技术也被用于治疗失语症。各种计算机语言培训项目的开发为失语症治疗带来了新希望。人们认为这些程序要么可以改善失语症治疗的费用效益,要么有助于开发新的治疗方法。
Despite the initial enthusiasm, most programs consist of repetitive drills with lack of flexibility and proved to be no good substitutes for a trained speech pathologist…Hopes for the future lay on
an increasingly thoughtful use of technology.” 49
大多数治疗方案包括重复练习和不可替代的受过专业训练的言语治疗师,希望未来的治疗越来越多的利用高科技产品。
The use of computers for some patients with severe aphasia can be almost life-saving. Icons, pictures and even simple words are represented on a screen and patients learn to point or manipulate them in order to express basic concepts. 50
对一些严重失语症患者来说,使用电脑几乎可以拯救生命。图标,图片和简单的词汇显示在屏幕上,患者点击或操纵他们,借以表达基本意愿。
Treating the whole patient患者的全面治疗
Dr. Martha T. Sarno was one of the early pioneers in recognizing the loss of language had vast implications on the individual and his or her community. One of the methods for dealing with the
various social and community issues, as well as individual and family difficulties, was to encourage the formation of aphasia support groups.
Martha博士是最早认识到“语言缺失对个人及其所处环境带来极大影响”的人之一。处理各种社会和家庭、个人问题的方法之一就是,鼓励建立失语症支持组织。
Group treatment for patients with aphasia has a great deal of support. There are community based groups. Major research centers for aphasia have support groups associated with them, as do many out-patient clinics. Most universities with speech and language pathology graduate programs also have communication disorder clinics associated with them which may include aphasia support groups.
小组治疗对失语患者的治疗很有帮助,例如社区治疗小组。大部分失语症研究中心都有许多支持组织,也有许多门诊病人。大部分开设语言病理学研究生课程的大学设有交流障碍门诊而这些门诊可能也包括失语症支持组织。
The idea is to help aphasics recover functional communication using all available techniques in a comprehensive manner.
这样做是为了综合利用各种手段促进失语症患者恢复交流功能。
As with other groups recovering from major illness or disability, groups can form a powerful social support network as well as opportunity to practice skills and share knowledge.
正如许多其他疾病或残疾康复团体,失语支持组织可以构建成一个强有力的社会支持网络,用以提供实践技能的机会和分享知识。
The Dalhousie School of Human Communication Disorders in Halifax, Nova Scotia has an intensive residential rehabilitation effort. This service, which is unique in Canada, is based on two main principles: research in aphasia has indicated that improved communication skills can be best facilitated through intensive treatment; and, communication does not occur in isolation, therefore partners must be actively involved in any communication intervention program.
Halifax Dalhousie人类交流障碍学院的Nova Scotia努力建立了完善的住院康复系统。这项服务,在加拿大是唯一的,有两个主要原则:失语症研究显示强化治疗可以最有效地提高沟通技巧;沟通不会单独存在,因此,任何交流干预计划都必须有拍档的积极参与。
The National Aphasia Association founded in 1987 is the first national association in the United States to focus on the person with aphasia and his or her family.
成立于1987年的国家失语症协会是美国第一个关注失语患者及其家庭的全国性协会。
Aphasia support groups are now found in almost state in the US. 51 The NAA lists the groups on its web site and points out: that the list “represents a wide variety of group types and structures. Some consist only of persons with aphasia and their significant others and some are more inclusive. Some are free and some are not.”
现在美国几乎所有州都有失语症支持组织。NAA网站上一一列出了这些组织,并指出:该列表包含了各种组织类型和结构。有些组织只包括失语症患者及其他亲友,有些则包含更多人。有些是免费的,有些则不是。
Pharmacotherapy药物治疗
The use of drugs in stroke has been largely limited either to stroke preventative measures or acute poststroke therapies administered to reduce damage.
用药以减少脑卒中患者损害---中风的预防或急性卒中后管理---在很大程度上受到限制。
Using adjunct drug therapies to improve communication has a sound theoretical basis, but the experimental evidence of real benefit remains unconvincing to some researchers.
辅以药物改善交流具有坚实的理论基础,但尚缺乏令人信服的实验证据证实患者能真正获益。
“Pharmacotherapy has not yet fulfilled its promise, despite many decades of effort.” 52
“尽管经过了几十年的努力,药物治疗还是没有发挥应有的效用。”
The drugs are utilized in conjunction with speech therapy and some promising work is being done in Germany with piracetam to facilitate rehabilitation of post-stroke aphasic patients. 53 Other drugs that have been tried include bromocriptine 54, 55 which was found helpful in high doses. Vasopressin used in Russia resulted in improvement in speech in 79% of cases.56 Other promising work has been done using amphetamines 57 and agents that influence specific neurotransmitter systems. 58
药物常于与言语治疗联合应用。德国正在努力研究吡拉西坦在促进脑卒中后失语症患者康复中的作用。人们发现,其他药物包括溴隐亭较高剂量时有助于失语症的康复。俄罗斯研究证实加压素使79%的患者言语功能改善,还有其他一些较有前景的研究以安非他明和影响特定神经递质系统的因子为研究对象。
“Selected linguistic capacities, including verbal fluency and verbal memory, appear to be influenced by specific neurotransmitter systems…At this moment, we are aware of no neurochemical agent that has yet been rigorously proven to ameliorate specific language signs or symptoms…The purpose of pharmacotherapy would not be to replace traditional language therapy.” 59
“特定语言功能,包括言语流畅性及口头记忆,似乎受特定神经递质系统的影响...目前尚未发现哪种神经化学因子可以改善特定言语症状或体征...药物治疗不会取代传统的言语治疗。
Future directions of therapy未来言语治疗的方向
•  “Further development of mechanisms to promote neural plasticity in adult humans;” and further development of behavioral techniques that optimize the re-laying of new neural networks within a more plastic cerebrum. 60
进一步发展病理机制的研究,以提高成人神经可塑性;进一步发展行为技术,在更具可塑性的大脑中优化神经网络的重新配置。
•  “Information gained from functional neuroimaging, in combination with behavioral assessment, could direct the therapist to target relatively left or right hemisphere language processes for treatment in a particular individual.” 61
“功能神经成像所获得的信息,结合行为评估,可以指导治疗师针对某人左或右半球损伤所致的语言障碍进行治疗
•  “Refinement of cognitive processing models so that they more closely approximate real brain
mechanisms… envision candidate treatment approaches specified for a patient might be tested in simulation.” 62
“提炼认知处理模型,使之更接近于真正的大脑机制…拟定针对特定患者的治疗方法在模拟测试中予以检验。
•  “Use novel biological therapies, including stem cell infusion, neuronal transplantation, and pharmacotherapy to make the brain more amenable to dramatic change in function… This will put new responsibilities on therapists, requiring a shift from‘effective therapy’ (by comparison with no therapy) to ‘beneficial therapies’ to achieve certain particular biological and behavioral goals.”  63
应用新的生物疗法,包括干细胞输注,神经移植,药物疗法,使大脑更适应功能损伤的变化...这将赋予治疗师新责任,完成从有效治疗(与没有治疗相比)到有益治疗的转变,以实现特定生物学行为为目标。
•  Increased understanding of role of specific neurotransmitters; defining optimal amount of drug treatment and timing effects on the recovery process…based on the increasing body of literature exploring the use of pharmacotherapy in aphasia therapy. 64
深入了解特定神经递质的作用,确定药物治疗的最佳剂量和最佳时机...需要以更多失语症药物治疗的文献为基础
About dysarthria 构音障碍
The dysarthrias are a group of diverse, chronic motor speech disorders in which patients are unable to speak with normal muscular speed, strength, precision, or timing. Dysarthria is a frequent symptom found in conditions such as Parkinson’s disease, cerebral palsy, amyotrophic lateral sclerosis, as well as being a complication of stroke.
构音障碍是一组表现多样的慢性语言运动障碍性疾病。患者肌肉收缩速度,力量,精度或时序异常致言语困难。构音障碍是帕金森氏症,脑瘫,肌萎缩性侧索硬化症等疾病的常见症状,也是脑卒中的常见并发症。
The location of the lesion or damage corresponds to a specific pattern of abnormal speech. The Mayo Clinic developed a classification system for six groups of dysarthria.
依据特定异常言语模式所对应的病变或损伤部位。Mayo Clinic将构音障碍分为6种类型。
The type of dysarthria determines the treatment.
构音障碍的类型决定治疗。
“Speech scientists have argued that the instrumental assessment of speech physiology provides more accurate and comprehensive information in neurological cases than do clinical speech tests…..(researchers have described) a sophisticated instrumental model for assessment of the dysarthric speaker. However, such a well-equipped speech laboratory is not available to many speech pathologists in the field….it appears that a combination of perceptual measures, nonspeech maneuvers, and instrumental measures provides the most reliable and valid assessment of dysarthria.” 65
“语言学家讨论过,语言生理学器械评定所提供的病例信息比临床语言测试更准确、更全面... ..(研究人员描述过)一个更高级的构音障碍器械评估模型。不过,这样装备精良的语音实验室对于该领域的许多言语治疗师来说都不现实...。看来,知觉测试,非言语演练和器械评估相结合是构音障碍评估是最可靠、最有效的评估方法。
In the treatment of dysarthrias,“the roles played by speech-language pathologists include participation in differential diagnosis, provision of speech treatment, staging of treatment, and timely education so that clients and families can make informed decisions about communication alternatives.” 66
构音障碍治疗中“语言治疗师所扮演的角色包括鉴别诊断、进行言语治疗、分期治疗、及时教育。目的是使患者及家属选择合适的交流方式。
Clinical guidelines for treatment of aphasia失语症治疗临床指南
United States美国
Current United States clinical guidelines 67 for post-stroke speech and language therapy recommend:
当前美国卒中后语言治疗临床指南介绍:
“Patients with aphasia should be offered treatment targeted at the identified language retrieval or comprehension deficits and aimed at improving functional communication.”
失语症患者的治疗应针对确定的语言提取或理解障碍,以改善交流功能为目的。”
This recommendation was a“consensus” recommendation, which means that 75 to 89 % of the reviewers agreed with it. (Strong consensus means that 90 % of the reviewers agree.)
这项建议是一项“共识”,即75至89%的评论家同意。(强有力的共识表示90%的评论家同意。)
The research evidence was “C” which means that the recommendation was supported by a single, nonrandomized controlled trial by studies using historical controls or studies using quasi-experimental designs such as pre- and post- treatment comparisons.
研究证据为“C”,这意味着该建议是由采用历史对照或准实验设计,如治疗前后相对比,的单因素非随机对照研究证明的。
Further comments:
进一步注解:
“Treatment for aphasia can be integrated with treatments for sensorimotor or cognitive deficits or can be provided separately. Treatment should involve family and caregivers so that effective communication can be reestablished….”
“失语症治疗与感觉运动或认知障碍的治疗可以综合进行,也可分别施予。治疗应有家庭成员和护理人员的参与,以重新建立有效的沟通...。“
“Evidence from controlled trials on the effectiveness of treatment for aphasia is not conclusive….Some studies indicate benefit…while other studies fail to document sustained benefits….Treatment by trained volunteers appears to be equally effective as that by speech and language professionals, and results appear to be unaffected by delaying treatment.”
“失语症疗效的对照试验证据并不确凿...一些研究表明受益...而另外一些研究证明疗效不持久...由受过训练的志愿者与专业言语治疗师所予治疗的疗效相似。预后不受干预介入时机的影响。
In addition, the guidelines have the following recommendations:
•  identify characteristics of patients most likely to benefit from rehabilitative interventions
•  determine optimal type of rehabilitation program for different types of patient
•  identify factors that affect optimal timing, intensity, and duration of rehabilitation
• determining effectiveness of specific treatments or combinations thereof, in reducing impairments
•  develop and validate standardized tests for monitoring post-stroke rehabilitation.
此外,该准则包括下列建议:
•确定最有可能从康复干预中获益的病例特点,
•确定不同类型患者的最优康复计划
•确定影响康复最佳时间,强度和持续时间的因素
•确定具体治疗或者其组合在减少损伤方面的疗效
•开发和验证监测卒中后康复的标准化评估方法
Scotland苏格兰
Scottish guidelines 68 state explicitly:
苏格兰指南明确指出:
“All patients with a communication problem resulting from a stroke should be referred to a speech and language therapist for assessment and treatment.”
“所有脑卒中引起交流障碍的患者都应该接受语言治疗师的评估和治疗。”
Further, the guidelines state:
此外,指南还提出:
“Family therapy involving aphasic patients and other family members improves handicap of the aphasic handicap and reduces depression and emotional isolation in patients.”
“由失语症患者及其家庭成员共同参与的家庭治疗,改善了失语症带来的社会功能障碍,减少了患者的抑郁情绪和情感上的孤立”。
“The efficacy of treatment for dysarthria has rarely been addressed, but benefits of early intervention are indicated.”
“构音障碍的治疗效果尚未证实,但早期干预能够获益已被证明。”
United Kingdom英国
Guidelines issued in the United Kingdom 69 state:
英国指南指出:
“Stroke can affect communication in different ways. The patient may have impaired motor speech production (dysarthria) resulting in unnatural or unintelligible speech; they may have impaired language skills (aphasia or dysphasia); or they may have impaired planning and execution of motor speech (articulatory dyspraxia). The patient may have subtle communication problems due to higher level language impairment associated with non-dominant hemisphere stroke. Untrained clinicians may misdiagnose the cause of abnormal communication. Accurate diagnosis is essential to guide and inform the team and the family. A speech and language therapist is the most competent person to assess a patient with abnormal communication.
卒中可以从多个途径影响交流。患者可能出现运动性语言生成障碍(构音障碍),导致不自然或令人难以理解的言语;可能存在语言技巧障碍(失语症或构音障碍);也可能存在运动性言语计划和执行障碍(发音困难的构音障碍)。非优势半球卒中致语言中枢严重受损可能只引起轻微交流障碍。未经过专业训练的临床医师可能误诊引起交流障碍的原因。准确的诊断对指导治疗小组和家庭成员是至关重要的。言语治疗师对交流障碍患者的评估是最有权威的。
•  Every patient with a dominant hemisphere stroke should be assessed for dysphasia using a reliable and valid method
即使优势半球中风的病人都应该使用可靠、有效的方法来评估其言语障碍。
•  Every patient with difficulties in communication should be assessed fully by a speech and language therapist (SLT)
每一个存在交流困难的患者都应由语言治疗师(SLT)进行全面评估。
•  If the patient has communication difficulties, the staff and relatives should be informed by the SLT of communication techniques appropriate to the impairment
如果病人沟通困难,言语治疗师就应该指导工作人员和亲属针对性的沟通技巧
•  Where achievable goals can be identified, and continuing progress demonstrated, patients with communication difficulties should be offered appropriate treatment, with monitoring of progress
一旦确定了治疗目标,且通过治疗症状持续改善,就应该为沟通困难的患者提供适合的治疗,并监测进展
•  Patients with specific communication difficulties should be assessed by a SLT as to their suitability for intensive speech and language therapy treatment which the trials suggest should be for a 4–8 week period
存在特殊交流困难的患者,需要言语治疗师进行评估,并进行为期4-8周的实验性治疗
•  For patients with long-term language difficulties, especially with reading, a period of reading retraining should be considered
对于长期语言障碍的患者,特别是阅读障碍,其治疗需包含一段时间的阅读训练
•  Any patient with severe communication disability but reasonable cognition and language should be assessed for and provided with appropriate alternative or augmentative communication aids.”
沟通严重残疾但认知和言语正常的患者,需要进行评估并给予适当的替代或辅助措施以助交流。
Tables of evidence supporting the recommendations appear for the guidelines. The criteria for recommendations are modeled on those used by the United States.
大量证据支持该指南所提的建议。收纳建议的标准参照美国标准。
Glossary of terms词表
This information is derived from the National Aphasia Association website. 70
此信息来自NAA网站
Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect mainly a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some channels remain accessible for a limited exchange of information.
失语症是指语言成生或理解,读写能力受损的言语功能障碍。失语症可以非常严重,以至于几乎无法与患者沟通,也可以非常轻。它可能主要影响言语功能的一个方面,例如命名、将单词连成句子或阅读。但是,更常见的是影响交流的多个方面,而有限的信息交流渠道尚存。
Global aphasia is the most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Global aphasics can neither read nor write. Global aphasia may often be seen immediately after the patient has suffered a stroke and it may rapidly improve if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result.
完全性失语是失语症中最严重的类型。患者仅能说出极少可辨别的词,极少或根本不理解别人的话。完全性失语患者既不能读也不能写。完全性失语多于中风后即刻出现,且如果损伤不是特别大,症状可能迅速改善。然而,如果脑损伤严重,可能造成严重持久的功能障碍。
Broca’s aphasia is a form of aphasia in which speech output is severely reduced and is limited mainly to short utterances, of less than four words. Vocabulary access is limited in persons with Broca’s aphasia, and their formation of sounds is often laborious and clumsy. The person may understand speech relatively well and be able to read, but be limited in writing. Broca’s aphasia is often referred to as a ‘non fluent aphasia’ because of the halting and effortful quality of speech. Broca’s失语,语言输出被严重削弱,仅能说少于4个字的短句。患者选词障碍,发音艰涩、笨拙。患者听理解相对完好,可以阅读,但书写障碍。由于言语常出现停顿且说话费力,Broca’s失语常被称为非流利性失语。
Mixed non-fluent aphasia is applied to patients who have sparse and effortful speech, resembling severe Broca’s aphasia. However, unlike persons with Broca’s aphasia, they remain limited in their comprehension of speech and do not read or write beyond an elementary level.
混合非流利性失语的病人讲话少且费力,类似严重的Broca’s失语。然而,与Broca’s失语不同的是,混合非流利性失语症患者听理解障碍,只能完成简单阅读和书写。
In Wernicke’s aphasia the ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected. Therefore Wernicke’s aphasia is referred to as a ‘fluent aphasia.’ However, speech is far from normal. Sentences do not hang together and irrelevant words intrude-sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired.
韦尼克失语的患者主要是言语理解功能受损,而言语连贯性影响不大。因此韦尼克失语症是被称为'流利性失语症'。但其言语极不正常。句与句之间缺乏衔接,常常插入无关词语,甚至有些严重病例类似说梦话。阅读和写作往往严重受损。
Anomic aphasia is applied to persons who are left with a persistent inability to supply the words for the very things they want to talk about-particularly the significant nouns and verbs. As a result their speech, while fluent in grammatical form and output is full of vague circumlocutions and expressions of frustration. They understand speech well, and in most cases, read adequately.
Difficulty finding words is as evident in writing as in speech.
命名性失语的患者无法说出他们想说的事物,特别是重要的名词和动词。因此,他们的语言虽然语法上通顺,但含糊不清、迂回、语意支离破碎。患者听理解正常,大多数病例阅读完好。说话和书写时找词困难非常明显。
Perseveration is susceptibility to interference from previous stimuli. In some cases this shows up as being unable to shift to a new category or activity. Behavior may also be continue inappropriately, for example, drawing extra loops when copying a multi-loop design. It may result from difficulty in disengaging attention from a stimuli.
持续言语是指对既往刺激的抗干扰能力受损。在某些情况下,表现为无法转移到一个新话题或活动。行为也可能不当,例如在复制多回路设计时画出额外的回路。患者可能难以从一个刺激中转移注意。
In addition to the foregoing syndromes that are seen repeatedly by speech clinicians, there are many other possible combinations of deficits that do not exactly fit into these categories. Some of the components of a complex aphasia syndrome may also occur in isolation.
除了上述临床医师再三强调的症状,可能存在其他的障碍组合----不一定完全符合这些类别。复杂失语综合征的某些症状可单独存在。
This may be the case for disorders of reading (alexia) or disorders affecting both reading and writing (alexia and agraphia), following a stroke. Severe impairments of calculation often accompany aphasia, yet in some instances patients retain excellent calculation in spite of the loss of language.
中风患者可能存在阅读障碍(失读症)或读写障碍(失读症和失写症)。严重计算障碍往往并发失语症。但有些病人虽然失语但计算力保留完好。
There are a variety of disorders of communication that may be due to paralysis, weakness, or incoordination of the speech musculature or to cognitive impairment. Such impairment may accompany aphasia or occur independently and be confused with aphasia. It is important to distinguish these disorders from aphasia because the treatment(s) and prognosis of each disorder are different.
很多交流障碍是由于发音肌瘫痪,软弱,不协调或认知功能障碍。这些损害可以与失语症并存,或单独发生,与失语混淆。区分这些障碍与失语非常重要,因为他们的治疗和预后不同。
Apraxia is a collective term used to describe impairment in carrying out purposeful movements. People with severe aphasia are usually extremely limited in explaining themselves by pantomime or gesture, except for expressions of emotion. Commonly they will show you something in their wallet, or lead you to show you something, but this is the extent of their non-verbal communication. Specific examination usually shows that they are unable to perform common expressive gestures on request, such as waving goodbye, beckoning, or saluting, or to pantomime drinking, brushing teeth, etc. (limb apraxia). Apraxia may also primarily affect oral, non-speech movements, like pretending to cough or blow out a candle (facial apraxia). This disorder may even extend to the inability to manipulate real objects. More often, however, apraxia is not very apparent unless one asks the patient to perform or imitate a pretended action. For this reason it is almost never presented as a complaint by the patient or the family. Nevertheless it may underlie the very limited ability of people with aphasia to compensate for the speech impairment by using informative gestures.
失用用以描述各种目的性运动障碍。严重失用症患者常难以用手势或动作示意,但可通过情绪表达。通常,他们会出示随身携带的物品或指给我们看,但这仅限于非语言交流。特殊检查常显示他们不能完成指定表达性动作,如摇手示意再见、招手、敬礼或打手势示意喝水、刷牙等(肢体失用)。失用症可能主要影响口腔、非言语动作,如假装咳嗽或吹熄蜡烛(面部失用)。这种功能障碍甚至可能累及使用物品的能力。但多数情况下,失用症并不十分明显,除非要求患者完成或模仿某一动作。因此多数情况下患者或家属并不以此为主诉。然而,失用可以影响失语症患者利用动作代偿言语障碍。
Apraxia of speech is a term frequently used by speech pathologists to designate an impairment in the voluntary production of articulation and prosody (the rhythm and timing) of speech. It is characterized by highly inconsistent errors.
言语失用常被言语治疗师用来命名随意言语的清晰度和韵律(节奏和时间)障碍。其特征是语意极不连贯。
Dysarthria refers to a group of speech disorders resulting from weakness, slowness, or incoordination of the speech mechanism due to damage to any of a variety of points in the nervous system. Dysarthria may involve disorders to some or all of the basic speech processes: respiration, phonation, resonance, articulation, and prosody. Dysarthria is a disorder of speech production not
language (e.g., use of vocabulary and/or grammar). Unlike apraxia of speech, the speech errors that occur in dysarthria are highly consistent from one occasion to the next.
构音障碍是指由于神经系统多点损伤致发音肌无力、迟缓或共济失调引起的一组语言障碍。构音障碍可以累及言语处理的某些或全部环节:呼吸、发音、共振、清晰度和韵律。构音障碍为言语生成障碍而非言语功能障碍(如词汇和/或语法)。与言语失用不同,构音障碍患者不同情况下发生的言语错误高度相关。
Dementia is a condition of impairment of memory, intellect, personality, and insight resulting from brain injury or disease. Some forms of dementia are progressive, such as Alzheimer’s disease, Picks disease, or some forms of Parkinson’s disease. Language impairments are more or less prominent in different forms of dementia, but these are usually overshadowed by more widespread intellectual loss. Since dementia is so often a progressive disorder, the prognosis is quite different
from aphasia.
痴呆为颅脑损伤或疾病引起的记忆、智能、人格和自知力障碍。某些类型的痴呆,病情不断进展,如阿尔兹海默病、皮克病或某些帕金森氏症。不同类型痴呆患者多多少少存在言语功能障碍,但常常被更广泛的智能缺失掩盖。因为痴呆不断进展,所以其诊断与失语症大不相同。

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