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Intensives Sprachtraining bei Aphasie

Einfluss kognitiver Faktoren

Intense language training for aphasia

Contribution of cognitive factors

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Zusammenfassung

Der beste Prädiktor für die therapieinduzierte Spracherholung nach einem Schlaganfall ist eine hohe Trainingsintensität (mit 5–10 Therapiestunden/Woche). Tägliche mehrstündige Übungseinheiten stellen jedoch hohe Anforderungen an die kognitiven Ressourcen der Patienten und könnten daher nicht für alle Betroffenen gleichermaßen geeignet sein. In diesem Beitrag wird zunächst beleuchtet, welche nichtsprachlichen kognitiven Beeinträchtigungen eine schlaganfallbedingte Aphasie häufig begleiten. Zudem werden erste empirische Ergebnisse darüber zusammengefasst, welche kognitiven Leistungen den Erfolg intensiver Sprachtherapie nach einem Schlaganfall begünstigen. Patienten in der akuten Phase profitieren dann am häufigsten von intensivem Sprachtraining, wenn die Fähigkeit zur Langzeitgedächtniskonsolidierung weitestgehend erhalten ist. Für Patienten in der chronischen Phase gibt es bislang nur indirekte Hinweise, dass eine höhere prämorbide Intelligenz und erhaltene Aufmerksamkeitsfunktionen günstige Effekte haben. Eine empiriegeleitete Zuweisung von Patienten zu intensiver Sprachtherapie wird erst nach Untersuchungen mit hinreichend großen Patientenzahlen möglich sein.

Abstract

The best predictor of successful language therapy after stroke is a high intensity of treatment (with 5–10 h training per week). However, the necessity of several hours of language exercises each day draws considerably on attentional and cognitive resources of the patients. Thus, not all aphasic patients may be equally suited for intense training approaches. In the present review non-verbal cognitive deficits that often accompany a stroke-induced aphasia are described. Furthermore, initial empirical data on cognitive functions, which predict the success of therapy (intense) after stroke, are summarized. Patients in the acute stage benefit most from intense aphasia treatment, when long-term memory consolidation is relatively preserved. For the chronic stage, indirect evidence suggests that premorbid intelligence as well as attentional functions have positive effects on the success of intense therapy. An empirically based allocation of patients to intense aphasia treatment awaits the results of multicenter trials with sufficiently large sample sizes.

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Danksagung

Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung (BMBF: 01GW0520), die Volkswagen-Stiftung (Az. I/80 708) sowie ein Marie Curie Research and Training Network: Language and Brain der European Commission (MRTN-CT-2004-512141) unterstützt. Wir danken Dr. Inta Jacobi für das kritische Lektorat einer vorhergehenden Version des Manuskripts.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48149, Münster, Deutschland

    C. Breitenstein, K. Kramer, M. Meinzer, A. Flöel & S. Knecht

  2. Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    A. Baumgärtner

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  1. C. Breitenstein
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  2. K. Kramer
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  3. M. Meinzer
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  4. A. Baumgärtner
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  5. A. Flöel
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  6. S. Knecht
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Correspondence to C. Breitenstein.

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Breitenstein, C., Kramer, K., Meinzer, M. et al. Intensives Sprachtraining bei Aphasie. Nervenarzt 80, 149–154 (2009). https://doi.org/10.1007/s00115-008-2571-6

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  • DOI: https://doi.org/10.1007/s00115-008-2571-6

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