经颅直流电刺激对卒中后失语患者视听觉通道命名的效果
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摘要
目的观察经颅直流电刺激(tDCS)对恢复期卒中后失语患者视听觉通道命名能力的影响。方法 2018年3月至11月,32例恢复期卒中后失语患者随机分为对照组和实验组,各16例。实验组在左侧额下回(L-IFG)实施阳极tDCS,对照组实施假tDCS,刺激的同时行语言训练。治疗前和治疗2周后,采用西方失语症成套测试(WAB)、图片命名测试和环境声音命名测试进行评定。结果对照组15例、实验组16例完成实验。治疗后,两组WAB失语商均显著提高(t> 5.081, P <0.001),治疗前后差值两组间无显著性差异(t=1.550, P> 0.05);两组图片命名评分均明显提高(Z> 2.650, P <0.01),治疗前后差值实验组高于对照组(Z=-2.258, P <0.05);实验组WAB实物命名评分明显提高(Z=-3.239, P <0.01),治疗前后差值实验组明显高于对照组(Z=-3.008, P <0.01);实验组环境声音命名评分显著提高(t=-4.745, P <0.001),治疗前后差值实验组高于对照组(t=2.224, P <0.05);实验组WAB自发命名、WAB完成句子、WAB反应命名评分均提高(Z> 2.191, P <0.05),对照组WAB自发命名评分提高(Z=-2.376, P <0.05),治疗前后差值两组间均无显著性差异(Z <1.568, P> 0.05)。结论 tDCS阳极刺激L-IFG对视觉和听觉通道的命名能力均有改善作用,可能通过影响语义或语音加工提高命名能力。
Objective To observe the effects of transcranial direct current stimulation(tDCS) on the naming of visual and auditory modality in patients with post-stroke aphasia.Methods From March to November, 2018, 32 patients with post-stroke aphasia were randomly divided into control group(n = 16) and treatment group(n = 16). The treatment group accepted anodal-tDCS(A-tDCS) over left-inferior frontal gyrus(L-IFG) concurrent with speech training, while the control group accepted sham-tDCS. Before and two weeks after treatment, they were assessed with Western Aphasia Battery(WAB), Picture Naming Test and Environmental Sound Naming Test.Results One patient was lost in the control group. After treatment, Aphasia Quotient of WAB improved in both groups(t > 5.081, P < 0.001), but the difference before and after treatment was not significantly different between two groups(t = 1.550, P > 0.05); the Picture Naming Test score improved in both groups(Z > 2.650, P < 0.01), and the difference before and after treatment was more in the treatment group than in the control group(Z =-2.258,P < 0.05); the object naming score of WAB improved in the treatment group(Z =-3.239, P < 0.01), and the difference before and after treatment was more in the treatment group than in the control group(Z =-3.008, P <0.01); the score of Environment Sound Naming Test improved in the treatment group(t =-4.745, P < 0.001),and the difference before and after treatment was more in the treatment group than in the control group(t =2.224, P < 0.05). The scores of spontaneous naming, sentences complement and reaction naming of WAB improved in the treatment group(Z > 2.191, P < 0.05), while the score of spontaneous naming of WAB improved in the control group(Z =-2.376, P < 0.05), but the differences before and after treatment were not significantly different between two groups(Z < 1.568, P > 0.05).Conclusion A-tDCS over L-IFG may improve the naming ability of visual and auditory modality, which may associate with semantic or phonetic processing.
Objective To observe the effects of transcranial direct current stimulation(tDCS) on the naming of visual and auditory modality in patients with post-stroke aphasia.Methods From March to November, 2018, 32 patients with post-stroke aphasia were randomly divided into control group(n = 16) and treatment group(n = 16). The treatment group accepted anodal-tDCS(A-tDCS) over left-inferior frontal gyrus(L-IFG) concurrent with speech training, while the control group accepted sham-tDCS. Before and two weeks after treatment, they were assessed with Western Aphasia Battery(WAB), Picture Naming Test and Environmental Sound Naming Test.Results One patient was lost in the control group. After treatment, Aphasia Quotient of WAB improved in both groups(t > 5.081, P < 0.001), but the difference before and after treatment was not significantly different between two groups(t = 1.550, P > 0.05); the Picture Naming Test score improved in both groups(Z > 2.650, P < 0.01), and the difference before and after treatment was more in the treatment group than in the control group(Z =-2.258,P < 0.05); the object naming score of WAB improved in the treatment group(Z =-3.239, P < 0.01), and the difference before and after treatment was more in the treatment group than in the control group(Z =-3.008, P <0.01); the score of Environment Sound Naming Test improved in the treatment group(t =-4.745, P < 0.001),and the difference before and after treatment was more in the treatment group than in the control group(t =2.224, P < 0.05). The scores of spontaneous naming, sentences complement and reaction naming of WAB improved in the treatment group(Z > 2.191, P < 0.05), while the score of spontaneous naming of WAB improved in the control group(Z =-2.376, P < 0.05), but the differences before and after treatment were not significantly different between two groups(Z < 1.568, P > 0.05).Conclusion A-tDCS over L-IFG may improve the naming ability of visual and auditory modality, which may associate with semantic or phonetic processing.
引文
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[13]李泓钰,王强,王静,等.经颅直流电刺激对卒中后抑郁的疗效[J].中国康复理论与实践,2018,24(5):565-570.
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[15]张清芳,杨玉芳.影响图画命名时间的因素[J].心理学报,2003,35(4):447-454.
[16]Fang Y,Han Z,Zhong S,et al.The semantic anatomical network:evidence from healthy and brain-damaged patient populations[J].Hum Brain Mapp,2015,36(9):3499-3515.
[17]Fang Y,Wang X,Zhong S,et al.Semantic representation in the white matter pathway[J].PLoS Biol,2018,16(4):e2003993.
[18]Han Z,Ma Y,Gong G,et al.White matter structural connectivity underlying semantic processing:evidence from brain damaged patients[J].Brain,2013,136(10):2952-2965.
[19]Vestito L,Rosellini S,Mantero M,et al.Long-term effects of transcranial direct-current stimulation in chronic post-stroke aphasia:a pilot study[J].Front Hum Neurosci,2014,8:785.
[20]汪洁,吴东宇,宋为群,等.双额叶在线经颅直流电刺激对失语症图命名的作用[J].中国康复医学杂志,2014,29(1):31-35.
[21]肖露,魏凤芹,牟谷萼,等.经颅直流电刺激对脑卒中恢复期Broca失语患者图命名能力的影响[J].中华物理医学与康复杂志,2015,37(11):810-813.
[22]槐雅萍,左秀芹,尹昱,等.经颅直流电刺激对脑卒中患者失语症恢复的影响[J].中国康复理论与实践,2016,22(10):1137-1140.
[23]Marcell M M,Borella D,Greene M,et al.Confrontation naming of environmental sounds[J].J Clin Exp Neuropsychol,2000,22(6):830-864.
[24]Ballas J A,Howard J H.Interpreting the language of environmental sounds[J].Environ Behav,1987,19(1):91-114.
[25]Saygin A P,Dick F,Bates E.An online task for contrasting auditory processing in the verbal and nonverbal domains and norms for younger and older adults[J].Behav Res Methods,2005,37(1):99-110.
[26]Brandt J,Bakker A,Maroof D A.Auditory confrontation naming in Alzheimer's disease[J].Clin Neuropsychol,2010,24(8):1326-1338.
[27]舒华,柏晓利,韩在柱,等.词汇表征和加工理论及其认知神经心理学证据[J].应用心理学,2003,9(2):41-45.
[28]Indefrey P,Levelt W J.The spatial and temporal signatures of word production components[J].Cognition,2004,92(1-2):101-144.
[29]Price C J,Friston K J.Cognitive conjunction:a new approach to brain activation experiments[J].Neuroimage,1997,5(4 Pt1):261-270.
[30]Price C J.The anatomy of language:contributions from functional neuroimaging[J].J Anat,2000,197(Pt 3):335-359.
[31]Lewis J W,Wightman F L,Brefczynski J A,et al.Human brain regions involved in recognizing environmental sounds[J].Cereb Cortex,2004,14(9):1008-1021.
[32]王穗苹,黄健.语言理解中的语义加工:不同模态神经影像的研究[J].生理学报,2019,71(1):127-139.
[33]Lau E F,Phillips C,Poeppel D.A cortical network for semantics:(de)constructing the N400[J].Nat Rev Neurosci,2008,9(12):920-933.
[34]Marangolo P,Fiori V,Calpagnano M A,et al.tDCS over the left inferior frontal cortex improves speech production in aphasia[J].Front Hum Neurosci,2013,7(2):539-549.
[35]Marangolo P,Fiori V,Campana S,et al.Something to talk about:enhancement of linguistic cohesion through tDCS in chronic non fluent aphasia[J].Neuropsychologia,2014,53(1):246-256.
[36]Russo C,Souza Carneiro M I,Bolognini N,et al.Safety review of transcranial direct current stimulation in stroke[J].Neuromodulation,2017,20(3):215-222.
[37]关龙舟,魏云,李小俚.经颅电刺激--一项具有发展前景的脑刺激技术[J].中国医疗设备,2015,30(11):1-5.
[38]Chhatbar P Y,George M S,Kautz S A,et al.Quantitative reassessment of safety limits of tDCS for two animal studies[J].Brain Stimul,2017,10(5):1011-1012.
[2]徐舒,李泓钰,杜晓霞,等.经颅直流电刺激治疗脑卒中后失语研究进展[J].中国现代神经疾病杂志,2018,18(6):461-466.
[3]陈文莉,单春雷.非侵入性脑刺激在失语症治疗中的应用[J].中华物理医学与康复杂志,2014,36(1):67-71.
[4]de Aguiar V,Paolazzi C L,Miceli G.tDCS in post-stroke aphasia:the role of stimulation parameters,behavioral treatment andpatient characteristics[J].Cortex,2015,63:296-316.
[5]Montenegro I R,Alvarez-Montesinos J A,Estudillo A J,et al.Direct current electrical stimulation in the treatment of aphasia[J].Rev Neurol,2017,65(12):553-562.
[6]Gomez Palacio Schjetnan A,Faraji J,Metz G A,et al.Transcranial direct current stimulation in stroke rehabilitation:a review of recent advancements[J].Stroke Res Treat,2013,2013:170256.
[7]Marangolo P,Fiori V,Di Paola M,et al.Differential involvement of the left frontal and temporal regions in verb naming:a tDCS treatment study[J].Restor Neurol Neurosci,2013,31(1):63-72.
[8]Caramazza A.How many levels of processing are there in lexical access?[J].Cogn Neuropsychol,1997,14(1):177-208.
[9]Hamberger M J,Goodman R R,Perrine K,et al.Anatomic dissociation of auditory and visual naming in the lateral temporal cortex[J].Neurology,2001,56(1):56-61.
[10]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[11]Nitsche M A,Bikson M.Extending the parameter range for tDCS:safety and tolerability of 4 mA stimulation[J].Brain Stimul,2017,10(3):541-542.
[12]Chhatbar P Y,Chen R,Deardorff R,et al.Safety and tolerability of transcranial direct current stimulation to stroke patients-a phase I current escalation study[J].Brain Stimul,2017,10(3):553-559.
[13]李泓钰,王强,王静,等.经颅直流电刺激对卒中后抑郁的疗效[J].中国康复理论与实践,2018,24(5):565-570.
[14]Rhoton A L Jr.The cerebrum[J].Neurosurgery,2002,51(Suppl 4):1-51.
[15]张清芳,杨玉芳.影响图画命名时间的因素[J].心理学报,2003,35(4):447-454.
[16]Fang Y,Han Z,Zhong S,et al.The semantic anatomical network:evidence from healthy and brain-damaged patient populations[J].Hum Brain Mapp,2015,36(9):3499-3515.
[17]Fang Y,Wang X,Zhong S,et al.Semantic representation in the white matter pathway[J].PLoS Biol,2018,16(4):e2003993.
[18]Han Z,Ma Y,Gong G,et al.White matter structural connectivity underlying semantic processing:evidence from brain damaged patients[J].Brain,2013,136(10):2952-2965.
[19]Vestito L,Rosellini S,Mantero M,et al.Long-term effects of transcranial direct-current stimulation in chronic post-stroke aphasia:a pilot study[J].Front Hum Neurosci,2014,8:785.
[20]汪洁,吴东宇,宋为群,等.双额叶在线经颅直流电刺激对失语症图命名的作用[J].中国康复医学杂志,2014,29(1):31-35.
[21]肖露,魏凤芹,牟谷萼,等.经颅直流电刺激对脑卒中恢复期Broca失语患者图命名能力的影响[J].中华物理医学与康复杂志,2015,37(11):810-813.
[22]槐雅萍,左秀芹,尹昱,等.经颅直流电刺激对脑卒中患者失语症恢复的影响[J].中国康复理论与实践,2016,22(10):1137-1140.
[23]Marcell M M,Borella D,Greene M,et al.Confrontation naming of environmental sounds[J].J Clin Exp Neuropsychol,2000,22(6):830-864.
[24]Ballas J A,Howard J H.Interpreting the language of environmental sounds[J].Environ Behav,1987,19(1):91-114.
[25]Saygin A P,Dick F,Bates E.An online task for contrasting auditory processing in the verbal and nonverbal domains and norms for younger and older adults[J].Behav Res Methods,2005,37(1):99-110.
[26]Brandt J,Bakker A,Maroof D A.Auditory confrontation naming in Alzheimer's disease[J].Clin Neuropsychol,2010,24(8):1326-1338.
[27]舒华,柏晓利,韩在柱,等.词汇表征和加工理论及其认知神经心理学证据[J].应用心理学,2003,9(2):41-45.
[28]Indefrey P,Levelt W J.The spatial and temporal signatures of word production components[J].Cognition,2004,92(1-2):101-144.
[29]Price C J,Friston K J.Cognitive conjunction:a new approach to brain activation experiments[J].Neuroimage,1997,5(4 Pt1):261-270.
[30]Price C J.The anatomy of language:contributions from functional neuroimaging[J].J Anat,2000,197(Pt 3):335-359.
[31]Lewis J W,Wightman F L,Brefczynski J A,et al.Human brain regions involved in recognizing environmental sounds[J].Cereb Cortex,2004,14(9):1008-1021.
[32]王穗苹,黄健.语言理解中的语义加工:不同模态神经影像的研究[J].生理学报,2019,71(1):127-139.
[33]Lau E F,Phillips C,Poeppel D.A cortical network for semantics:(de)constructing the N400[J].Nat Rev Neurosci,2008,9(12):920-933.
[34]Marangolo P,Fiori V,Calpagnano M A,et al.tDCS over the left inferior frontal cortex improves speech production in aphasia[J].Front Hum Neurosci,2013,7(2):539-549.
[35]Marangolo P,Fiori V,Campana S,et al.Something to talk about:enhancement of linguistic cohesion through tDCS in chronic non fluent aphasia[J].Neuropsychologia,2014,53(1):246-256.
[36]Russo C,Souza Carneiro M I,Bolognini N,et al.Safety review of transcranial direct current stimulation in stroke[J].Neuromodulation,2017,20(3):215-222.
[37]关龙舟,魏云,李小俚.经颅电刺激--一项具有发展前景的脑刺激技术[J].中国医疗设备,2015,30(11):1-5.
[38]Chhatbar P Y,George M S,Kautz S A,et al.Quantitative reassessment of safety limits of tDCS for two animal studies[J].Brain Stimul,2017,10(5):1011-1012.
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