مقایسه آموزش آرام سازی و تحریک سینتکس برای زبان پریشی مزمن

This study examined the effects of relaxation training and syntax stimulation on the spoken language abilities of a 59-year-old male with chronic, nonfluent aphasia of moderate severity. Relaxation training consisted of progressive muscle relaxation (PMR) and guided imagery (GI), whereas the syntax stimulation was a modified version of the Helm Elicited Program for Syntax Stimulation (HELPSS) [(1981). Helm Elicited Language Program for Syntax Stimulation. Austin, TX: Pro-Ed.]. These treatments were applied in the context of a single-subject alternating treatments plus baseline design. Results indicated that although both treatments produced improvements in spoken language, syntax stimulation was associated with larger improvements, particularly in terms of the proportions of grammatical utterances, correct information units (CIUs), and successful utterances produced by the participant. Analysis of treatment order, however, indicated that the participant's best performances of the syntax treatment and of the probe tasks occurred when relaxation training preceded syntax stimulation. These findings suggest that the simplicity and psychological benefits of relaxation training make it a complementary component to traditional linguistic programs for aphasia. Educational objectives: (1) The reader will understand how psychological responses to stress may affect the language processing abilities of adults with aphasia. (2) The reader will be able to describe how relaxation training complements a traditional language treatment approach for remediating spoken language abilities of adults with chronic nonfluent aphasia.

Recently, increased attention has been given to the description of the psychological and psychosocial effects of aphasia Gainotti, 1997, Herrmann, 1997, Herrmann & Wallesch, 1989, Le Dorze & Brassard, 1995, Sapir & Aronson, 1990 and Servaes et al., 1999. That is, in addition to their communication problems, patients with aphasia have been found to experience depression, anger, frustration, anxiety, social isolation, and family tension and conflict, as well as a variety of other psychological, social, and professional stresses. Importantly, these psychological factors may influence the rate and amount of recovery made by patients with aphasia Robinson & Benson, 1981 and Sapir & Aronson, 1990. For example, depression and other emotional reactions, and the inability to express these emotions may negatively affect the desire of the aphasic patient to communicate and interact with others. Furthermore, emotional disturbances have been found to interfere with the language formulation and comprehension abilities not only of other patient populations, such as adults with Parkinson's disease, but also adults with no brain damage Bolla-Wilson et al., 1989, Christenfeld & Creager, 1996, Christensen et al., 1997 and Poewe & Luginger, 1999. Initial findings suggest that stress may place an additional burden upon the already fragile language skills of patients with aphasia (Heeschen, Ryalls, & Hagoort, 1988). Consequently, aphasia assessments and treatments have begun to evolve from an exclusive focus on linguistic abilities to include the psychosocial reintegration and the psychotherapeutic care of patients with aphasia and their families. In terms of assessment, tools such as the Visual Mood Analogue Scales (Stern, 1998) and the Psychological Well Being Scale (Hoen, Thelander, & Worsley, 1997) have been developed or adapted to document the emotional status and general well-being of aphasic patients. Regarding treatment, approaches such as counseling the patient with aphasia Cunningham, 1998 and Ireland & Wotton, 1996, providing cotherapy to the patient and his or her spouse Lyon, 1998 and Stiell & Gailey, 1995, and training community communication partners (Lyon et al., 1997) have been utilized to address the chronic emotional and social consequences of living with aphasia. Relaxation training is another treatment method that has been used to reduce frustration, anxiety, and general stress factors in both non-brain-damaged and brain-damaged adults Poppen, 1988, Rankin et al., 1993, Rimm & Masters, 1974 and Yesavage, 1984. Relaxation training also has been shown to improve memory functioning in the elderly Yesavage, 1984 and Yesavage & Jacob, 1984, public speaking abilities of college students (Mandeville, 1991), and memory, behavior, and verbal fluency in adults with mild to moderate dementia Snyder & Olson, 1996 and Suhr et al., 1999. In terms of communication disorders, relaxation training has been used to reduce anxiety, stress, and other emotional difficulties in individuals with speech fluency Azrin et al., 1979 and Hasbrouck & Lowry, 1989 and voice problems Andrews et al., 1986 and Mueller & Larson, 1992. Despite the prevalence of such problems in adults with aphasia, the utility of relaxation training for the treatment of aphasia has received little investigative scrutiny. The exception to this paucity of research is a study by Marshall and Watts (1976). These researchers examined how relaxation training, more specifically, progressive muscle relaxation (PMR), affected the naming abilities of 16 adults with moderate to severe aphasia of unspecified type. Relaxation training was administered individually to each participant during 30-min treatment sessions. Each participant also completed a control session during which he or she sat in the same treatment room for the same amount of time as the relaxation training, performing neither relaxation techniques nor linguistic activities. Confrontation naming, object function naming, repetition, and sentence completion tests were given no less than 10 min following the relaxation and control sessions. Group performances on each of these spoken language tests were higher following relaxation vs. control sessions, with significant differences observed for the naming task and for overall test performances (i.e., average performance on all language tests). Marshall and Watts speculated that PMR training reduced anxiety, which in turn improved the spoken language abilities of the aphasic participants. They also noted that relaxation training seemed to have greater positive effects on more difficult spoken language tasks. That is, their aphasic participants tended to achieve better accuracy following PMR on the harder confrontation naming and object function-naming tests. In contrast, the facilitative effects of PMR were less apparent for the easier repetition and sentence completion tasks. Interestingly, these findings accord well with limited capacity models of language processing. Capacity theories specify that the processing load associated with producing or comprehending an utterance reflects the amount of cognitive resources or fuel used to store and compute lexical, semantic, syntactic, and pragmatic information Haarmann et al., 1997 and Just & Carpenter, 1992. These theories also propose that there is only a limited or finite pool of cognitive resources available at any given time. If this limited capacity of resources is exceeded by the processing load of an incoming or outgoing linguistic message, any previously computed linguistic information may be lost, further linguistic processing may be slowed, or both. Anxiety, frustration, or stress may interfere with language production and comprehension by placing an additional load upon this finite pool of cognitive resources, leaving fewer resources available to dedicate to linguistic processing. In adults with aphasia, emotional stresses may be particularly detrimental as it has been hypothesized that aphasia represents a pathological reduction in resource capacity, the ability to allocate these resources, or both Miyake et al., 1995, Murray, 1999 and Tseng et al., 1993. Therefore, for adults with aphasia, relaxation training may result in improved language performance if it reduces the processing load associated with emotional reactions and thus, leaves more resources available to dedicate to language processing. Given that only one published study to date has investigated relaxation training for aphasia, the purpose of the present study was to examine the effectiveness of a relaxation training program in OL, a patient with chronic, moderate, nonfluent aphasia. Because OL was particularly interested in improving his productive syntax abilities (i.e., he wanted to be able to “say the little words”), the effects of relaxation training were compared to those of a more traditional, syntax stimulation program [i.e., a modification of the Helm Elicited Program for Syntax Stimulation (HELPSS); Helm-Estabrooks, 1981] using an alternating treatment design. The following research questions were examined: 1. Does relaxation training affect the spoken language abilities (i.e., proportion of grammatically complete utterances, mean length of utterances (MLUs), percentage of correct information units (%CIUs), and proportion of successful utterances) of an adult with chronic, nonfluent aphasia? 2. Which treatment program, relaxation training or syntax stimulation yields greater gains in the spoken language abilities of an adult with chronic, nonfluent aphasia?