强制诱导语言治疗对慢性运动性失语患者语言恢复及脑功能重组的影响

The effect of constraint-induced aphasia on language recovery and functional reorganization of the brain in Broca＇s aphasia after a stroke

目的通过BOLD—fMRI成像显示强制诱导语言治疗前、后慢性运动性失语患者语言功能及脑功能成像的特征差异，探讨强制诱导语言治疗对脑卒中慢性运动性失语患者脑功能重组的影响。方法选择符合标准的脑卒中后慢性运动性失语患者2例，在常规语言治疗进入恢复平台期情况下给予强制诱导语言治疗，每次持续治疗1．5h，每天治疗2次，共治疗30h（2周内完成）。于治疗前、治疗后接受图片命名任务下的fMRI检查及汉语标准失语症检查。结果本研究入选慢性运动性失语患者经4周常规语言训练后其语言功能有较大幅度提高，第8周、第12周时语言功能改变不明显（进入平台恢复期），第14周时发现患者经强制诱导语言治疗后其语言功能有进一步改善。本研究入选患者经强制诱导语言治疗后，其左侧额下回激活出现或增强（P〈0．005），伴或不伴左侧半球多个脑区激活增加及右侧额下回激活减弱。结论强制诱导语言治疗改善慢性失语患者语言功能的机制可能与上调左侧额下回激活、下调右侧额下回激活或是促进双侧额叶、颞叶多个脑区乃至整个语言功能网络重组有关。

Objective To explore the impact of constraint-induced aphasia therapy （CIAT） on language function and neural activity in patients with chronic Broca＇s aphasia. Methods Two chronic aphasics whose use of language was recovering after standard language therapy were selected to receive 1.5 h of CIAT twice daily for two weeks （30 hours in total）. Before and after the CIAT they were tested using a block-designed picture-naming task, fMRIs were taken and their use of language was examined. Results The language function assessments showed rela- tively large improvements in the subjects＇ use of language after 4 weeks of conventional language training, but not much further change after 8 and 12 weeks. After the two weeks of CIAT, their language function improved further to a certain extent, fMRI showed increased activation in the left inferior frontal gyrus with or without enhanced activation in the left hemisphere, and reduced activation in the right inferior frontal gyrus. Conclusions Functional reorganization induced in the brain by CIAT was associated with up-regulation of the left inferior frontal gyrus or down-regulation of the right inferior frontal gyrus. Even the whole language network may have been modified.