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Allgemeiner Beitrag

Intensivierung, Fokussierung und Verhaltensrelevanz

Published Online:September 01, 2006https://doi.org/10.1024/1016-264X.15.3.219

Abstract

Zusammenfassung: Gehirnwissenschaftliche Erkenntnisse der vergangenen Jahre haben neue neuropsychologische Therapieformen hervorgebracht, deren allgemeine Prinzipien sich mit den Termini Intensivierung, Verhaltensrelevanz und Fokussierung umreißen lassen (genannt Constraint-Induced Aphasia Therapy - CIA Therapie). Intensivierung der Therapie bedeutet, dass die Intervention mit besonders hoher Frequenz durchgeführt wird (engl.: massed practice). Die im therapeutischen Setting implementierten Interaktionstypen gleichen denjenigen im Alltag (behavioral relevance). “Fokussierung” heißt, dass der Patient durch Hilfsmittel und Regeln der therapeutischen Interaktion zu Handlungsweisen gebracht wird, die er aufgrund operanter Konditionierungen in Folge der Gehirnschädigung sonst vermeiden würde (constraints to avoid learned nonuse). In einer kontrollierten Effektivitätsstudie konnten wir beweisen, dass CIA Therapie auch bei chronischer Aphasie zu einer signifikanten Verbesserung der sprachlichen Leistungen führen kann. Wir gehen hier auf die historischen Wurzeln ein und diskutieren Fragen für zukünftige Forschungen.


Massed Practice, Constraints on Verbal Communication and Behavioral Relevance as Principles of Neuropsychological Rehabilitation and Their Implementation in the Therapy of Patients with Chronic Aphasia

Summary: This article introduces a new approach to neuropsychological therapy of chronic language disturbances called Constraint-Induced Aphasia (CIA) therapy. General principles of the new procedure include massed practice, behavioral relevance, and the application of constraints to prevent learned nonuse. Massed practice implies an intensive application of therapy, with high frequency (several hours per day). In behaviorally relevant therapeutic settings, the practicing of impaired functions is done in a context that resembles everyday activities. The new therapeutic approach uses constraints, for example by introducing rules and instrumental aids, that focus the patient on performing actions he would normally avoid due to aversive conditioning consequent to brain lesion (learned nonuse). In a controlled clinical trial, we were able to demonstrate the success of CIA therapy, a new therapeutic approach that follows all these general principles, in stroke patients with chronic language disability. We address the theoretical foundations of CIA therapy, its historical roots and some issues for future research.

References

  • Aftonomos, L.B., Appelbaum, J.S., Steele, R.D. (1999). Improving outcomes for persons with aphasia in advanced community-based treatment programs.. Stroke, 30, 1370–1379. First citation in articleCrossref, Google Scholar

  • Andrews, K., Stewart, J. (1979). Stroke recovery: He can but does he?. Rheumatology and Rehabilitation, 18, 43–48. First citation in articleCrossref, Google Scholar

  • Baayan, H., Piepenbrock, R., van Rijn, H. (1993). The CELEX lexical database (CD-ROM).. University of Pennsylvania, PA: Linguistic Data Consortium.. First citation in articleGoogle Scholar

  • Basso, A., Capitani, E., Vignolo, L.A. (1979). Influence of rehabilitation on language skills in aphasic patients: A controlled study.. Archives of Neurology, 36, 190–196. First citation in articleCrossref, Google Scholar

  • Davis, G.A., Wilcox, M.J. (1981). Incorporating parameters of natural conversation in aphasia treatment.. In R. Chapey (Ed.), Language intervention strategies in adult aphasia. Baltimore: Williams & Wilkins.. First citation in articleGoogle Scholar

  • Davis, G.A., Wilcox, M.J. (1985). Adult aphasia rehabilitation: Applied pragmatics.. San Diego: College-Hill.. First citation in articleGoogle Scholar

  • Dobel, C., Hauk, O., Zobel, E., Eulitz, C., Pulvermüller, F., Cohen, R., Schönle, P.W., Rockstroh, B. (1998). Monitoring brain activity of healthy subjects during delayed matching to sample tasks: An event-related potential study employing a source reconstruction method.. Neuroscience Letters, 253, 179–182. First citation in articleCrossref, Google Scholar

  • Dobel, C., Pulvermüller, F., Härle, M., Cohen, R., Koebbel, P., Schönle, P.W., Rockstroh, B. (2001). Syntactic and semantic processing in the healthy and aphasic human brain.. Experimental Brain Research, 140(1), 77–85. First citation in articleCrossref, Google Scholar

  • Duncan, P.W. (1997). Synthesis of intervention trials to improve motor recovery following stroke.. Top Stroke Rehabilitation, 3(4), 1–20. First citation in articleGoogle Scholar

  • Elbert, T., Flor, H., Birbaumer, N., Knecht, S., Hampson, S., Larbig, W., Taub, E. (1994). Extensive reorganization of the somatosensory cortex in adult humans after nervous system injury.. Neuroreport, 5, 2593–2597. First citation in articleCrossref, Google Scholar

  • Elbert, T., Pantev, C., Wienbruch, C., Rockstroh, B., Taub, E. (1995). Increased cortical representation of the fingers of the left hand in string players.. Science, 270, 305–307. First citation in articleCrossref, Google Scholar

  • Elman, R.J., Bernstein-Ellis, E. (1999). The efficacy of group communication treatment in adults with chronic aphasia.. Journal of Speech, Language and Hearing Research, 411–419. First citation in articleGoogle Scholar

  • Fritz, G., Hundsnurscher, F. Hrsg. (1994). Handbuch der Dialoganalyse.. Tübingen: Niemeyer Verlag.. First citation in articleCrossref, Google Scholar

  • Greitemann, G. (1988). Sprache.. In D. von Cramon, D. & J. Zihl, J. (Hrsg.), Neuropsychologische Rehabilitation. Berlin: Springer-Verlag.. First citation in articleCrossref, Google Scholar

  • Heiss, W.D., Kessler, J., Thiel, A., Ghaemi, M., Karbe, H. (1999). Differential capacity of left and right hemispheric areas for compensation of poststroke aphasia.. Annals of Neurology, 45, 430–438. First citation in articleCrossref, Google Scholar

  • Holland, A.L., Fromm, D.S., DeRuyter, F., Stein, M. (1996). Treatment efficacy: Aphasia.. Journal of Speech and Hearing Research, 39, 27–36. First citation in articleCrossref, Google Scholar

  • Huber, W., Poeck, K., Weniger, D., Willmes, K. (1983). Aachener Aphasie Test (AAT).. Handanweisung. Göttingen: Beltz Verlag.. First citation in articleGoogle Scholar

  • Katz, R.C., Wertz, R.T. (1997). The efficacy of computer-provided reading treatment for chronic aphasic adults.. Journal of Speech, Language and Hearing Research, 40, 493–507. First citation in articleCrossref, Google Scholar

  • Kertesz, A. (1984). Recovery from aphasia.. Advances in Neurology, 42, 23–39. First citation in articleGoogle Scholar

  • Kopp, B., Kunkel, A., Mühlnickel, W., Villringer, K., Taub, E., Flor, H. (1999). Plasticity in the motor system correlated with therapy-induced improvement of movement in human stroke patients.. Neuroreport, 10, 807–810. First citation in articleCrossref, Google Scholar

  • Kunkel, A., Kopp, B., Müller, G., Villringer, K., Villringer, A., Taub, E., Flor, H. (1999). Constraint-induced movement therapy for motor recovery in chronic stroke patients.. Archives of Physical Medicine and Rehabilitation, 80, 624–628. First citation in articleCrossref, Google Scholar

  • Leff, A., Crinion, J., Scott, S., Turkheimer, F., Howard, D., Wise, R. (2002). A physiological change in the homotopic cortex following left posterior temporal lobe infarction.. Annals of Neurology, 51, 553–558. First citation in articleCrossref, Google Scholar

  • Liepert, J., Miltner, W.H., Bauder, H., Sommer, M., Dettmers, C., Taub, E., Weiller, C. (1998). Motor-cortex plasticity during constraint-induced movement therapy in stroke patients.. Neuroscience Letters, 250, 5–8. First citation in articleCrossref, Google Scholar

  • Liepert, J., Bauder, H., Miltner, W.H.R., Taub, E., Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans.. Stroke, 31, 1210–1216. First citation in articleCrossref, Google Scholar

  • Liepert, J., Graef, S., Uhde, I., Leidner, O., Weiller, C. (2000a). Training-induced changes of motor cortex representations in stroke patients.. Acta neurologica Scandinavica, 101, 321–326. First citation in articleCrossref, Google Scholar

  • Lincoln, N.B., Mc Guirk, E., Muller, G.P., Lendrem, W., Jones, A.C., Mitchell, J.R.A. (1984). Effectiveness of speech therapy for aphasic stroke patients: A randomized controlled trial.. Lancet, 1, 1197–1200. First citation in articleCrossref, Google Scholar

  • Luria, A.R. (1970). Traumatic aphasia.. The Hague: Mouton.. First citation in articleCrossref, Google Scholar

  • Meinzer, M., Elbert, T., Taub, E., Pulvermüller, F., Wienbruch, C., Rockstroh, B. (in Vorbereitung). Extending the Constraint-Induced Therapy (CIT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia.. . First citation in articleGoogle Scholar

  • Merzenich, M.M., Nelson, R.J., Stryker, M.P., Cynader, M.S., Shoppmann, A., Zook, J.M. (1984). Somatosensory cortical map changes following digit amputation in adult monkeys.. Journal of Comparative Neurology, 224, 591–605. First citation in articleCrossref, Google Scholar

  • Miltner, W.H.R., Bauder, H., Sommer, M., Dettmers, C., Taub, E. (1999). Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke.. A Replication. Stroke, 30, 586–592. First citation in articleCrossref, Google Scholar

  • Musso, M., Weiller, C., Kiebel, S., Müller, S.P., Bulau, P., Rijntjes, M. (1999). Training-induced brain plasticity in aphasia.. Brain, 122, 1781–1790. First citation in articleCrossref, Google Scholar

  • Neininger, B. (2002). Sprachverarbeitung außerhalb der klassischen Sprachzentren. Online. Konstanzer Online-Publikations-System.. Available: www.ub.uni-konstanz.de/kops/volltexte/2002/879 20. August 2002.. First citation in articleGoogle Scholar

  • Nudo, R.J., Wise, B.M., SiFuentes, F., Milliken, G.W. (1996). Neural substrates for the effects of rehabilitative training on motor recovery following ischemic infarct.. Science, 272, 1791–1794. First citation in articleCrossref, Google Scholar

  • Oldfield, R.C. (1971). The assessment and analysis of handedness: The Edinburgh inventory.. Neuropsychologia, 9, 97–113. First citation in articleCrossref, Google Scholar

  • Papanicolaou, A.C., Levin, H.S., Eisenberg, H.M. (1984). Evoked potential correlates of recovery from aphasia after focal left hemisphere injury in adults.. Neurosurgery, 14, 412–415. First citation in articleCrossref, Google Scholar

  • Parker, V.M., Wade, D.T., Langton Hewer, R. (1986). Loss of arm function after stroke: Measurement, frequency, and recovery.. International Rehabilitation Medicine, 8, 69–73. First citation in articleCrossref, Google Scholar

  • Pedersen, P.M., Jorgensen, H.S., Nakayama, H., Raaschou, H.O., Olsen, T.S. (1995). Aphasia in acute stroke: Incidence, determinants, and recovery.. Annals of Neurology, 38, 659–666. First citation in articleCrossref, Google Scholar

  • Pulvermüller, F. (1987). Kommunikative Therapie der Broca-Aphasie.. Sprache-Stimme-Gehör, 11, 115–118. First citation in articleGoogle Scholar

  • Pulvermüller, F. (1989). Kommunikative Therapie der amnestischen Aphasie.. Sprache-Stimme-Gehör, 13, 32–35. First citation in articleGoogle Scholar

  • Pulvermüller, F. (1989a). Sprachliches Handeln im Alltag und in der Aphasietherapie.. In V.M. Roth (Hrsg.), Kommunikation trotz gestörter Sprache. Tübingen: Narr.. First citation in articleGoogle Scholar

  • Pulvermüller, F. (1990). Aphasische Kommunikation: Grundfragen ihrer Analyse und Therapie.. Tübingen: Narr.. First citation in articleGoogle Scholar

  • Pulvermüller, F. (1990a). Untersuchung kommunikativer Fähigkeiten bei Patienten mit neuropsychologischen Defiziten.. In R. Mellies, F. Ostermann & A. Winnecken (Hrsg.), Beiträge zur interdisziplinären Aphasieforschung. Tübingen: Narr.. First citation in articleGoogle Scholar

  • Pulvermüller, F. (1994). Sprachstörungen im Dialog - Analyse und Therapie.. In G. Fritz & F. Hundsnurscher (Hrsg.), Handbuch der Dialoganalyse. Tübingen: Niemeyer Verlag.. First citation in articleCrossref, Google Scholar

  • Pulvermüller, F., Roth, V.M. (1991). Communicative aphasia treatment as a further development of PACE therapy.. Aphasiology, 5, 39–50. First citation in articleCrossref, Google Scholar

  • Pulvermüller, F., Roth, V.M. (1993). Integrative und computerunterstützte Aphasietherapie.. In M. Grohnfeldt (Hrsg.) Handbuch der Sprachtherapie. Band IV: Zentrale Sprach- und Sprechstörungen.Berlin: Wissenschaftsverlag Volker Spiess.. First citation in articleGoogle Scholar

  • Pulvermüller, F., Schönle, P.W. (1993). Behavioral and neuronal changes during treatment of mixed-transcortical aphasia: A case study.. Cognition, 48, 139–161. First citation in articleCrossref, Google Scholar

  • Pulvermüller, F., Mohr, B. (1996). The concept of transcortical cell assemblies: A key to the understanding of cortical lateralization and interhemispheric interaction.. Neuroscience and Biobehavioral Reviews, 20, 557–566. First citation in articleCrossref, Google Scholar

  • Pulvermüller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., Taub, E. (2001). Constraint-induced therapy of chronic aphasia following stroke.. Stroke, 32, 1621–1626. First citation in articleCrossref, Google Scholar

  • Sarno, M.T., Silverman, M., Sands, E. (1970). Speech therapy and language recovery in severe aphasia.. Journal of Speech and Hearing Research, 13, 607–623. First citation in articleCrossref, Google Scholar

  • Schuell, H. (1974). Aphasia theory and therapy.. Baltimore: Univ. Park Press.. First citation in articleGoogle Scholar

  • Schweinberger, S.R., Landgrebe, A., Mohr, B., Kaufmann, J.M. (2002). Personal names and the human right hemisphere: An illusory link?. Brain and Language, 80, 111–120. First citation in articleCrossref, Google Scholar

  • Shewan, C.M., Kertesz, A. (1984). Effects of speech and language treatment on recovery of aphasia.. Brain and Language, 23, 272–299. First citation in articleCrossref, Google Scholar

  • Snodgrass, J.G., Vanderwart, M. (1980). A standardized set of 260 pictures: Norms for name agreement, image agreement, familiarity, and visual complexity.. Journal of Experimental Psychology and Human Learning, 6, 174–215. First citation in articleCrossref, Google Scholar

  • Sterr, A., Müller, M.M., Elbert, T., Rockstroh, B., Pantev, C., Taub, E. (1998). Changed perceptions in Braille readers.. Nature, 391, 134–135. First citation in articleCrossref, Google Scholar

  • Taub, E. (1976). Motor behavior following deafferentiation in the developing and motorically mature monkey.. In R. Herman, S. Grillner, H.J. Ralston, P.S.G. Stein & D. Stuart (Eds.), Neural control of locomotion. New York: Plenum.. First citation in articleGoogle Scholar

  • Taub, E. (1977). Movement in nonhuman primates deprived of somatosensory feedback.. Exercise and Sports Science Reviews, 4, 335–374. First citation in articleGoogle Scholar

  • Taub, E. (1980). Somatosensory deafferentation research with monkeys: Implications for rehabilitation medicine.. In L.P. Ince (Ed.), Behavioral psychology in rehabilitation medicine: Clinical applications.New York: William & Wilkins.. First citation in articleGoogle Scholar

  • Taub, E., Bacon, R., Berman, A.J. (1965). The acquisition of a trace-conditioned avoidance response after deafferentiation of the responding limb.. Journal of Comparative Physiology and Psychology, 58, 275–279. First citation in articleCrossref, Google Scholar

  • Taub, E., Miller, N.E., Novack, T.A., Cook, E.W. 3rd, Fleming, W.C., Nepomuceno, C.S., Connell, J.S., Crago, J.E. (1993). Technique to improve chronic motor deficit after stroke.. Archives of Physical Medicine and Rehabilitation, 74, 347–354. First citation in articleGoogle Scholar

  • Taub, E., Crago, J.E., Burgio, L.D., Groomes, T.E., Cook, E.W. 3rd, DeLuca, S.C., Miller, N.E. (1994). An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping.. Journal of the Experimental Analysis of Behavior, 61, 281–293. First citation in articleCrossref, Google Scholar

  • Taub, E., Crago, J.E., Uswatte, G. (1998). Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation.. Rehabilitation Psychology, 43, 152–170. First citation in articleCrossref, Google Scholar

  • Taub, E., Uswatte, G., Pidikiti, R. (1999). Constraint-induced movement therapy: A new family of techniques with broad application to physical rehabilitation - a clinical review.. Journal of Rehabilitation Research and Development, 36, 237–251. First citation in articleGoogle Scholar

  • Thompson, C. (2000). The neurobiology of language recovery in aphasia.. Brain and Language, 71, 245–248. First citation in articleCrossref, Google Scholar

  • Thulborn, K.R., Carpenter, P.A., Just, M.A. (1999). Plasticity of language related brain function during recovery from stroke.. Stroke, 30, 749–754. First citation in articleCrossref, Google Scholar

  • Uswatte, G., Taub, E. (1999). Constraint-Induced Movement Therapy: New approaches to outcome measurement in rehabilitation.. In D.T. Stuss, G. Winocur & I.H. Robertson, (Eds.), Cognitive neurorehabilitation: A comprehensive approach.Cambridge: University Press.. First citation in articleGoogle Scholar

  • Weigl, E. (1981). Neuropsychology and neurolinguistics.. The Hague: Mouton.. First citation in articleGoogle Scholar

  • Weiller, C., Isensee, C., Rijntjes, M., Huber, W., Müller, S., Bier, D., Dutschka, K., Woods, R.P., North, J., Diener, H.C. (1995). Recovery from Wernicke's aphasia: A positron emission tomography study.. Annals of Neurology, 37, 723–732. First citation in articleCrossref, Google Scholar

  • Wepman, J.N. (1953). Recovery from aphasia.. New York.. First citation in articleGoogle Scholar

  • Wertz, R.T., Collins, M.J., Weiss, D., Kurtzke, J.F., Friden, T., Brookshire, R.H., Pierce, J., Holtzapple, P., Hubbard, D.J., Porch, B.E., West, J.A., Davis, L., Matovitch, V., Morley, G.K., Resurreccion, E. (1981). Veterans Administration cooperative study on aphasia: A comparison of individual and group treatment.. Journal of Speech and Hearing Research, 24, 580–594. First citation in articleCrossref, Google Scholar

  • Wertz, R.T., Weiss, D.G., Aten, J.L., Brookshire, R.H., Garcia-Bunuel, L., Holland, A.L., Kurtzke, J.F., LaPointe, L.L., Milianti, F.J., Brannagan, R., Greenbaum, H., Marshall, R.C., Vogel, D., Carter, J., Barnes, N.S., Goodman, R. (1986). Comparison of clinic, home, and deferred language treatment for aphasia: A Veterans Administration cooperative study.. Archives of Neurology, 43, 653–658. First citation in articleCrossref, Google Scholar

  • Wilcox, M.J., Davis, G.A. (1978). Procedures for promoting communicative effectiveness in aphasic adult.. San Francisco: Miniseminar presented at the Annual Convention of American Speech and Hearing Association.. First citation in articleGoogle Scholar

  • Wittgenstein, L. (1953). Philosophical Investigation.. Oxford: Blackwell.. First citation in articleGoogle Scholar