強迫性失語療法讓中風病患能再次言語

新技術產顯著增進語言能力

  研究人員在七月份Stroke: Journal of the American Heart Association指出,在對中風癱瘓後病患,進行強迫誘導行動治療(constraint-induced movement therapy),療效非常成功。他們發現,與傳統的治療相較之下,不給予失語病患任何口語上的引導暗示,將能使他們增進語言能力。

Constraining Aphasic Stroke Patients to Speak

Novel Technique Produces Marked Language Improvement

By Michael W. Smith, MD
WebMD Medical News

Reviewed by Jacqueline Brooks MBBCh, MRCPsych

Aug. 6, 2001 -- Building on the success of constraint-induced movement therapy for paralyzed poststroke patients, researchers in the July issue of Stroke: Journal of the American Heart Association have found that forbidding the use of nonverbal clues in aphasic patients can produce pronounced language improvements compared with conventional treatment.

"There is a changing paradigm in treatment of stroke injuries; we have new insights due to improvements in basic science. The psychological basis of recovery is the neuroplasticity of the brain, its ability to reorganize itself and adapt to new needs, new demands," co-author Thomas Elbert, PhD, tells WebMD. "Traditional wisdom says these patients couldn't possibly improve. However, with only short-term treatment, we saw a significant improvement."

Elbert, professor of clinical psychology and cognitive neuroscience at Germany's University of Konstanz, and colleagues followed poststroke patients with chronic Broca's aphasia and randomly assigned them to either conventional treatment or constraint-induced (CI) aphasia therapy, in which all nonverbal cues are not permitted and ignored as a form of communication.

The subjects in the CI group were required to make attempts at communicating with words and sentences -- not utterances -- in order to be heard while involved in various games and tests. Seven subjects received 30-35 hours of conventional therapy, during a 4-week period. The remaining ten received 30-35 hours of CI therapy over 10 days.

CI aphasia therapy produced significant language improvements on 3 of 4 standard clinical tests whereas the conventional treatment group exhibited improvement in only 1 of 4 of the tests.

"Now we have to see if we can design even better forms of treatment, more realistic games with increased motivation," Elbert says. "This was only a short-term treatment, so I think we will see increased gains by making the training more efficient and intense."

"This study does provide evidence that improvement in language functioning can occur long after the patient has plateaued in recovery and is no longer making gains on their own," says David A. Olson, MD, behavioral neurologist at Georgia Regional Hospital, in Atlanta.

"The strengths of this study are the rigorous constraint-induced aphasia treatment protocol, the random assignments to the control or treatment groups, and the "blindness" of the posttreatment raters to the form of treatment that the patients received," he says.

"The primary weakness of this study is that it is a small study with a lot of noise in the system. Both groups vary in the type of aphasia treated, the duration of the deficit, and handedness patterns. Also, the authors present only aggregated outcome data, so it is difficult to tell if a few treated patients with large gains accounted for the improvement, or if smaller, but significant, improvements occurred in the majority of the treatment group," says Olson.

However, Elbert tells WebMD that all patients in the CI group did show improvement.

Further studies are needed to evaluate if these results are long lasting since, "posttreatment testing occurred on the day after the last treatment, so we do not know if these benefits were sustainable," Olson says.

"While I don't know of any programs in the United States which specifically offer constraint-induced aphasia therapy, the University of Florida has pioneered several cognitive restorative programs that employ similar methodologies," Olson says.

With reporting by Elaine Zablocki

© 2001 WebMD Corporation. All rights reserved.

    
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