应用心理语言评定探讨1例听失认的语言加工损害机制

摘要

目的：应用汉语失语症心理语言评定系统明确听失认患者的诊断，探讨其语言加工损害水平，并预测其语言功能的预后。方法对1例左侧颞岛顶叶、右侧颞岛叶、双侧基底节脑梗死所致的听理解严重障碍的患者，采用汉语失语症语言评定系统在发病后4周进行首次语言评定，并对其进行语言训练，发病后8周、3个月再次进行评定，分析其语言加工损害机制及预后。结果患者发病4周后，听觉词-图匹配和视觉词-图匹配正确率分别为2.5%和95.0%(P<0.001)；听觉语义知识和视觉语义知识正确率为5.6%和80.6%(P<0.001)；进一步的听觉输入通路相关检查发现得分均很低，包括声母韵母声调听辨别、最小差异单字听判断、环境声音识别；看图命名正确率67.5%，词复述0，词朗读70.0%，听写0，直接抄写100.0%；发病8周和3个月后语言评定显示，视觉词-图匹配(均100%)、视觉语义知识(97.2%、100%)完全恢复；看图命名(87.5%、90%)、词朗读(87.5%、97.5%)、看图书写(77.5%、87.5%)和抄写(均100%)有所改善；而听觉词-图匹配(5.0%、7.5%)、听觉语义知识(2.8%、5.6%)、复述(0、3.3%)和听写(均为0)未见改变。结论该例以听理解障碍(尤其是听觉语音识别缺陷)为主要语言障碍的患者诊断为听失认。通过3次评定可预测其语言功能的预后，提高这种特殊类型语言障碍患者治疗的针对性。%Objective To evaluate the damaged level of auditory processing and diagnose the type of language impairment in an audito-ry agnosia patient using Psycholinguistic Assessment in Chinese Aphasia (PACA), and predict the outcome of the language function. Meth-ods A patient with a bilateral damage involving the temporal lobe could physically hear the sounds, but was unable to recognize or differenti-ate between the sounds. Speech and language evaluations were taken with PACA 4 weeks, 8 weeks and 3 months after the onset of disease. Results At 4 weeks, the correct rates were 2.5%and 95.0%in spoken word-picture matching and written word-picture matching (P<0.001), and were 5.6%and 80.6%in spoken semantic knowledge and written semantic knowledge (P<0.001). The scores of auditory input process-ing function score were low, including phoneme discrimination, spoken word matching with minimal differences, environmental sounds identification. The correct rates were 67.5%in oral picture naming, 0 in word repetition, 70.0%in word reading, 0 in dictation, 100.0%in di-rectly copy writing. At 8 weeks and 3 months, there was complete recovery in written word-picture matching (both 100%) and written se-mantic knowledge (97.2%, 100%), and improvement in oral picture naming (87.5%, 90%), word repetition (87.5%, 97.5%), picture name writing (77.5%, 87.5%) and copy writing (both 100%) (P<0.05). But no change was found in auditory input processing function examina-tions, spoken word-picture matching (5.0%, 7.5%), spoken semantic knowledge (2.8%, 5.6%), word repetition (0, 3.3%) and dictation (both 0). Conclusion The patient was diagnosed as auditory agnosia with the inability to distinguish sounds. PACA can well identify the impaired level of auditory comprehension disorder and the outcome of language function recovery for aphasics.