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Resumen El presente texto es el resultado de una investigación etnográfica en el servicio de rehabilitación neurológica en el Centro de Atención de Salud Mental y Neurológica en la Ciudad de México. Este trabajo centra su problemática en dilucidar cómo se reconstruye el lenguaje corporal de las personas con afasia motora y qué sentidos generan. El análisis de la información recopilada nos llevó a identificar que la rehabilitación del lenguaje reconstruye una gramática corporal y emplea a la capacidad de narrar con el fin de restaurar el lenguaje y la comunicación. En ese sentido, retomamos la noción de franjas de actividad de Goffman, de embodiment de Csordas y de polifonía de Bajtín, para comprender la construcción discursiva del lenguaje que se introyecta en el cuerpo y se reproduce durante la interacción clínica. La metodología empleada fue la realización de una etnografía del contexto clínico que emplea a las narrativas como herramienta idónea para describir el sentido construido entre terapeutas y personas afectadas con afasia motora.
Abstract This text is the result of an ethnographic research conducted in the neurological rehabilitation service at the Center for Mental and Neurological Health Care in Mexico City. This work focuses its problematic on elucidating how the body language of people with motor aphasia is reconstructed and what senses they generate. The analysis of the collected information led us to identify that language rehabilitation reconstructs a body grammar and uses the ability to narrate in order to restore language and communication. In this sense, we follow Goffman's notion of strip of activity, Csordas' embodiment and Bakhtin's polyphony, in order to understand the discursive construction of language that is introjected into the body and reproduced during clinical interaction. The employed methodology was an ethnography of the clinical context using narratives as a suitable tool to describe the meaning constructed between therapists and people affected with motor aphasia.
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OBJECTIVE@#To compare the clinical efficacy between scalp acupuncture electrical stimulation and routine scalp acupuncture for motor aphasia in subacute stage of cerebral infarction.@*METHODS@#A total of 54 patients with motor aphasia in subacute stage of cerebral infarction were randomly divided into an observation group (27 cases, 1 case dropped off) and a control group (27 cases, 2 cases dropped off ). Both groups were treated with routine medication and language training. In the observation group, scalp acupuncture was given at bilateral lower 2/5 of the parietal and temporal anterior oblique line and temporal frontline; after the arrival of @*RESULTS@#After treatment, the scores of listening comprehension, retelling, naming, spontaneous conversation and BDAE grade in the two groups were improved compared with those before treatment (@*CONCLUSION@#The scalp acupuncture electrical stimulation could improve cerebral circulation, activate specific functional areas of cerebral cortex, and promote the reconstruction and recovery of brain language function. Its curative effect is better than conventional scalp acupuncture.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Aphasia, Broca , Cerebral Infarction/therapy , Electric Stimulation , Scalp , Stroke , Treatment OutcomeABSTRACT
Objective:To explore the effect of working memory updating training on verbal fluency for patients with motor aphasia. Methods:From June, 2015 to June, 2018, 80 patients with motor aphasia were randomly divided into control group (n = 40) and study group (n = 40). The control group accepted routine speech training, while the study group accepted working memory updating training in addition, for eight weeks. They were assessed updating function and verbal fluency before and after training. Results:The updating function and verbal fluency improved in the study group after training (t > 2.418, P < 0.05), and were better than those in the control group (t > 2.407, P < 0.05). Conclusion:Working memory updating training can improve both speech and cognition for patients with motor aphasia.
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Objective To investigate the recovery mechanism of brain function in patients with mo-tor aphasia after cerebral infarction by resting-state functional magnetic resonance imaging (fMRI) functional connectivity. Methods 10 patients with aphasia after cerebral infarction (aphasia group),and 10 patients without aphasia (control group)in the same period were enrolled.Both patients underwent resting-state fMRI examination.Patients with aphasia received a second fMRI examination 1 month later.The SPM8 software and DPARSF software were used to process the data.The back of the left middle frontal gyrus ( LFMG) was se-lected as the seed point for functional connectivity analysis.REST was used for pairing and two-sample t-tests. Results Compared with the control group,the brain regions with increased LMFG-ROI functional connectiv-ity were right insula(MNI:x,y,z:45,12,0,t＝7.98),right inferior frontal gyrus (triangular,ankle,island cap) (MNI:x,y,z:42,6,27,t＝6.75),right upper temporal gyrus and right middle temporal gyrus( MNI:x, y,z:48,－45,6,t＝10.57),right superior border gyrus(MNI:x,y,z:15,－66,60,t＝5.59) and right angle gy-rus(MNI:x,y,z:54,－50,12,t＝9.55) in the aphasia group (before rehabilitation),and the brain regions with reduced functional connectivity were left posterior cingulate gyrus( MNI:x,y,z:6,－75,9,t＝－10.05), and left anterior wedge lobe(MNI:x,y,z:－6,－69,33,t＝－9.07).Compared with the control group,the brain regions with enhanced LMFG-ROI functional connectivity in the aphasia group (after rehabilitation 1 month) included head of left caudate nucleus,left middle frontal gyrus and inferior frontal gyrus,left globus pallidus, left central anterior gyrus,central posterior gyrus,left insula; the brain regions with reduced functional con-nectivity were right hippocampus,left cerebellum,right lingual gyrus,posterior left cingulate gyrus,right oc-cipital lobe and right anterior wedge lobe.Compared with aphasia group before rehabilitation,the brain regions with increased LMFG-ROI functional connectivity after rehabilitation 1 month were the left frontal frontal gy-rus(MNI:x,y,z:－51,15,24),t＝15.87),left frontal parietal island cover(MNI:x,y,z:－24,－66,42,t＝5.20),left central anterior gyrus and central posterior gyrus(MNI:x,y,z:－15,－16,55,t＝6.53); and the reduced brain regions were the right superior temporal gyrus and middle temporal gyrus(MNI:x,y,z:57,－18,30,t＝－15.21),right insula (MNI:x,y,z:－24,－66,42,t＝－5.20)and right superior border gyrus (MNI:x,y,z:15,－66,60,t＝－7.69). Conclusion The functional reorganization of the brain regions around the left hemisphere's injury lingual area may be the main mechanism of brain functional plasticity in patients with aphasia after cerebral infarction,and the right hemisphere is also involved in this process.In both the a-cute and chronic phases of motor aphasia,activation of the posterior left cingulate gyrus is reduced.
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En este trabajo se analiza el uso y las funciones de los marcadores discursivos en la producción de un paciente con afasia motora aferente. Se analiza un corpus proveniente de una entrevista semiestructurada realizada durante la terapia neuropsicológica. El objetivo es analizar cualitativamente el uso de los marcadores discursivos y las funciones que desempeñan a lo largo de las intervenciones del paciente. Se busca mostrar que los marcadores discursivos se conservan en este tipo de afasia porque funcionan como estrategias compensatorias que facilitan la comunicación del paciente y responden a los déficits particulares de la afasia motora aferente. El análisis de los datos muestra que el paciente emplea consistentemente cuatro tipos de marcadores discursivos: (i) conectores, (ii) reformuladores, (iii) formuladores y (iv) modalizadores, a pesar del déficit lingüístico que padece. Esto sugiere que los marcadores desempeñan funciones específicas que contribuyen a subsanar los problemas a los que se enfrenta el paciente durante la construcción de su intervención. Este hecho resulta consistente con los resultados previos obtenidos en otras variedades de afasia. Finalmente, esto contribuye a la idea de que en la afasia el nivel pragmático-discursivo sufre una desintegración menos drástica si se le compara con el nivel fonético-fonológico o el sintáctico
This paper analyzes use and functions of discourse markers in linguistic production of one speaker with afferent motor aphasia. A semi-structured interview carried out during neuropsychological therapy was analyzed. The aim of this study is to qualitatively analyze the use of discourse markers and the functions they perform in patient interventions. It attempts to show discourse markers are conserved in this type of aphasia because they perform as compensatory strategies which make patient communication easier and respond to the particular deficits which characterize this aphasia. Data analysis shows that the patient consistently uses four kinds of markers: (i) connectors, (ii) reformulators, (iii) formulators, and (iv) modalizers, despite pathology. This suggests that discourse markers perform specific functions which help to resolve the problems which the patient faces during construction of his intervention. This fact is consistent with the results obtained in previous studies with other aphasia varieties. Finally, this contributes to the notion that, in aphasia, pragmatic and discursive levels suffer a less drastic disintegration than that of the phonetic-phonological level orthe syntactic level
Subject(s)
Humans , Male , Adult , Aphasia/physiopathology , Semantics , Speech/physiology , Interview , Communication , Neuropsychological TestsABSTRACT
Objetivo. Las alteraciones derivadas del daño cerebral, como los síndromes afásicos, pueden desencadenar disfunciones en diferentes niveles de la actividad del paciente. La neuropsicología de Luria ha sido la disciplina dedicada a la caracterización funcional y al análisis rehabilitatorio de los síndromes afásicos. Con frecuencia, a este análisis se incorporan datos recogidos con técnicas neurolingüísticas y de neuroimagen (TAC, fMRI). Presentar un método de rehabilitación que, basado en los principios de Luria, demuestre la ventaja de utilizar una evaluación y un programa de rehabilitación relacionados con un diagnóstico para la creación de tratamientos para la afasia motora aferente. Método. Se llevó a cabo un estudio de caso en una paciente de 30 años de edad con reciente evento vascular cerebral, con evaluación pre y postratamiento. La evaluación inicial incluyó el diagnóstico neuropsicológico, para el cual se utilizó una batería de evaluación neuropsicológica para valoración de lenguaje. Durante un periodo de 16 semanas, se aplicó un programa de intervención rehabilitatoria neuropsicológica basado en las dificultades de articulación identificadas durante la evaluación inicial y dividido en un total de cuatro fases, con un objetivo específico cada una. Resultados. Se observó aumento en la habilidad para articular fonemas, disminución en las parafasias literales y un incremento en el lenguaje expresivo verbal del sujeto. Conclusión. La valoración asociada al trastorno de lenguaje específico de afasia motora aferente y el diseño de un tratamiento adecuado a las características de esta alteración ayudaron a corregir las dificultades de punto y modo de articulación observadas en este sujeto, así como a la reorganización de habilidades de pensamiento más complejas.
Objective. Brain-damage derived impairments, such as aphasic syndromes, can result in several levels of dysfunction in the subject's activity, such as aphasic syndromes. Neuropsychology is the discipline which is dedicated to the functional characterization of the rehabilitatory analysis of the aphasic syndromes. Frequently, data obtained with the help of neurolinguistics and neuroimaging techniques (CAT, fIRM) are used in neuropsychology. Using case analysis, to present a rehabilitation method based on Luria's principles which demonstrate the advantage of using an assessment and rehabilitation diagnosis-related program for the creation of treatment in afferent motor aphasia syndromes. Method. To achieve this goal a method of a case study was carried out on a 30 year old patient with a recent vascular cerebral event, with initial assessment and diagnosis, using a neuropsychological assessment battery designed for language evaluation, in individual sessions, and a final assessment over a period of sixteen weeks. A neuropsychological rehabilitation intervention program was designed, based on the articulation impairments identified during the first assessment, divided in a total of four phases, each one with a specific objective. Results. The patient showed an improvement in phoneme articulation skills, also a reduction in literal paraphasic symptoms, and an increase in the verbal expressive language of the subject. Conclusion. The motor afferent language specific assessment, and the design of a suitable treatment for the characteristics of this disorder, helped in the correction of the position and mode articulation difficulties observed in this subject, as well as reorganization of higher complex thinking skills.
Escopo. As alterações derivadas do dano cerebral, como os síndromes afásicos, podem desencadear disfunções em diferentes níveis da atividade do paciente. A neuropsicología de Luria tem sido a disciplina dedicada à funcional e análise reabilitatorio dos síndromes afásicos. Com frequência, a este análise são incorporados dados colhidos com técnicas neurolinguísticas e de neuroimagem. (TAC, fMRI). Apresentar um método de reabilitação baseado nos princípios de Luria que demostra a vantagem de utilizar uma avaliação e um programa de reabilitação relacionado ao diagnóstico para a criação de tratamentos para a afasia motora aferente. Metodologia. Foi levado a cabo um estudo de caso numa paciente de 30 anos de idade com recente evento vascular cerebral com avaliação pre e postratamento. A avaliação inicial incluiu o diagnóstico neuropsicológico, para o que foi utilizada uma bateria de avaliação neuropsicológica para valoração da linguagem. Durante um período de 16 semanas, foi aplicado um programa de intervenção reabilitatória neuropsicológica baseado nas dificuldades de articulação identificadas durante a avaliação inicial, dividido num total de quatro fases com um escopo específico cada uma. Resultados. Foi observado um aumento na habilidade para articular fonemas, diminuição nas parafasias literais e um incremento na linguagem expressiva verbal do sujeito. Conclusão. A valoração associada ao transtorno da linguagem específica de afasia motora aferente e o desenho de um tratamento adequado para as características de esta alteração ajudaram a corrigir as dificuldades de ponto e modo de articulação observadas neste sujeito, assim como a reorganização de habilidades de pensamento mais complexas.
Subject(s)
Humans , Aphasia, Broca , Language , RehabilitationABSTRACT
@#ObjectiveTo explore the effect of cluster needling of scalp acupuncture combined with rehabilitation(Tang's Approach) on depression of stroke patients with motor aphasia.Methods70 stroke patients were randomly divided into the acupuncture with rehabilitation group and the control group. The cluster needle of scalp point with speech rehabilitation training was used in the acupuncture with rehabilitation group, while speech rehabilitation training was used only in the control group. The degree of depression and aphasia were observed in the two groups 4 weeks after treament.Results 4 weeks after the treatment, the classification of aphasia was getting better in the acupuncture with rehabilitation group than in the control group(P＜0.05), and the incidence of depression decreased significantly in the acupuncture with rehabilitation group compared with the control group(P＜0.01). The score of Stroke Aphasic Depression Scale (SADQ) decreased significantly in the acupuncture with rehabilitation group compared with the control group (P＜0.01).ConclusionTang's Approach may improve the depression of stroke patients with motor aphasia.
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@#ObjectiveTo explore the effect of cluster needling of scalp acupuncture combined with rehabilitation(Tang's Approach) on depression of stroke patients with motor aphasia.Methods70 stroke patients were randomly divided into the acupuncture with rehabilitation group and the control group. The cluster needle of scalp point with speech rehabilitation training was used in the acupuncture with rehabilitation group, while speech rehabilitation training was used only in the control group. The degree of depression and aphasia were observed in the two groups 4 weeks after treament.Results 4 weeks after the treatment, the classification of aphasia was getting better in the acupuncture with rehabilitation group than in the control group(P＜0.05), and the incidence of depression decreased significantly in the acupuncture with rehabilitation group compared with the control group(P＜0.01). The score of Stroke Aphasic Depression Scale (SADQ) decreased significantly in the acupuncture with rehabilitation group compared with the control group (P＜0.01).ConclusionTang's Approach may improve the depression of stroke patients with motor aphasia.
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@#ObjectiveTo compare the effect of acupuncture and speech rehabilitation on motor aphasia after stroke with speech rehabilitation alone. Methods49 patients with aphasia were divided into treatment group (27 cases) and control group (22 cases) randomly. The cases in treatment group were treated with acupuncture and speech rehabilitation. The cases in control group were treated with speech rehabilitation alone. They were assessed before and 1 month, 3 months after treatment. ResultsThere was no significant difference between treatment group and control group 1 month after treatment (P>0.05), but was significant in auditory comprehension, speaking, reading, dictation and description (P<0.05) 3 months after treatment. ConclusionThe acupuncture can facilitate the recovery of motor aphas after stroke.
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@#Objective To observe the speech outcome of global aphasia after treatment.Methods 2 cases with global aphasia were trained using the Schuell aphasic stimulation approach,promoting aphasics communication effectiveness(PACE) and functional communication therapy(FCT),and assessed with the Standard Aphasia Examination of Chinese.Results Both patients showed obvious improvement.Conclusion The features of global aphasia can become as something of motor aphasia after speech training for several months or years.
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@#ObjectiveTo investigate the pathologic mechanism of motor aphasia.Methods25 patients with cerebral infarction and motor aphasia were examined by magnetic resonance spectroscopy (MRS) and perfusion weighted imaging (PWI) at Broca's areas, the results were compared with that of the mirror side.ResultsMRS showed that the N-acetyl aspartate, choline in Broca's areas reduced than that of the mirror side ( P<0.05); while PWI showed that the regional cerebral blood volume and regional cerebral blood flow of damaged Broca's areas decreased significantly than that of the right hemisphere ( P<0.01). Mean transit time and time to peak of damaged Broca's areas prolonged than that of mirror side ( P<0.05).ConclusionHypoperfusion and hypometabolism revealed in Broca's areas of patients with motor aphasia may be one of the mechanisms of motor aphasia.
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Objective To observe the effect of Xingnao Kaiqiao(Brain-resuscitating)Acupuncture plus language rehabilitation training for motor aphasia caused by cerebral infarction.Methods Totally 90 patients with motor aphasia were randomized into acupuncture plus language training group,single acupuncture group,and language training group(control group),with 30 in each.The Western Aphasia Battery(WAB)was adopted to evaluate the speaking functions of the patients.The aphasia quotient(AQ)of the patients,four basic speaking functions including spontaneous talk,spoken language understanding,retelling,and naming,and communicative ability in daily life(CADL)were observed.Results After treatment,AQ,CADL and score of spontaneous talk,spoken language understanding,retelling,and naming of the three groups were all significantly improved(P0.05).Conclusion Xingnao Kaiqiao Acupuncture plus language rehabilitation training for motor aphasia caused by cerebral infarction is effective with the superiority in improving the ability of spontaneous talk,retelling,naming and CADL.