ABSTRACT

Background

Treatment outcomes for functional communication, and for generalisation across languages and linguistic levels, remain mixed for bilinguals with aphasia (BWAs). Most studies on rehabilitation of BWAs report impairment-based approaches for participants with two broad similar Indo-European languages, but it remains unclear whether benefits extend to the untreated language or linguistic levels when the BWA speaks linguistically dissimilar languages. Furthermore, outcomes for communication-based approaches, where the components mirror everyday conversations and functional communication more closely, have rarely been examined in BWAs.

Aim

To examine the efficacy of Better Conversations with Aphasia (BCA), a dyadic communication-based treatment, in Mandarin for BWAs – direct treatment effects on conversations, impact on functional communication and emotional well-being, and generalisation both within and across languages.

Methods

Two Mandarin English-speaking bilingual adults with non-fluent aphasia (mild–moderate-to-severe) and their communication partner (CP) received BCA conducted in Mandarin for 1–1.5 h twice-weekly sessions over 10 weeks. The frequency of facilitators and barriers in conversation samples, questionnaires on functional communication and emotional well-being, a picture description task, and confrontation naming of nouns and verbs in both treated and untreated languages, were all assessed at baseline, post-treatment, and post-maintenance.

Results

Facilitators and barriers - Both BWAs and their CPs showed significant decreases in barrier-behavior frequencies, but P01 also showed a significant reduction in the use of facilitators. Functional Communication/Well-being - P01 reported positive effects for functional communication and emotional well-being, but P02 reported negative effects for both. No significant changes in the CPs’ ratings of the BWAs’ functional communication. Discourse - P01’s Mandarin narrative production showed no significant improvement but speech rate and efficiency improved for English picture descriptions. P02’s Mandarin picture descriptions contained significantly more words produced at a slower speech rate while significant gains in meaningfulness and efficiency were found in her English descriptions. Single-word - P01 showed improved confrontation naming accuracy for nouns (Mandarin only) and verbs (Mandarin and English), whereas P02 only showed significantly increased accuracy for verbs in English.

Conclusions

BCA treatment for two Mandarin English-speaking BWAs replicated earlier reports of positive direct treatment effects for monolingual PWAs, particularly the reduction of behaviors that hinder conversation success. Moreover, the generalisation, both within and across linguistically dissimilar languages, provides evidence for shared language networks that could be exploited by clinicians working with BWAs. The potential impact of culture, family context, linguistic structures, and cognitive deficits, on treatment outcome is also discussed.

中文翻译：

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为双语失语症患者及其交流伙伴提供的普通话双语会话培训

摘要

背景

对于双语失语症患者 (BWA) 的功能性交流以及跨语言和语言水平泛化的治疗结果仍然是混合的。大多数关于 BWA 康复的研究报告了针对具有两种广泛相似的印欧语言的参与者的基于损伤的方法，但是当 BWA 说语言上不同的语言时，益处是否扩展到未经治疗的语言或语言水平仍不清楚。此外，基于沟通的方法的结果，其中组件更密切地反映日常对话和功能沟通，很少在 BWA 中进行检查。

目标

用普通话检查 BCA 对失语症更好的对话 (BCA) 的效果，这是一种基于二元交流的治疗，用于 BWA 的普通话——治疗对对话的直接影响、对功能性交流和情绪健康的影响，以及语言内部和跨语言的泛化。

方法

两名患有非流利失语症（轻度至中度至重度）的讲普通话英语的双语成人及其交流伙伴 (CP) 接受了为期 10 周、每周两次、每次 1-1.5 小时的普通话 BCA。在基线、治疗后和后期维护。

结果

促进者和障碍——BWA 及其 CP 都显示障碍行为频率显着降低，但 P01 也显示促进者的使用显着减少。功能性沟通/幸福感——P01 报告了功能性沟通和情感幸福感的积极影响，但 P02 报告了两者的负面影响。CP 对 BWA 功能沟通的评级没有显着变化。话语- P01的普通话叙事制作没有显着改善，但英语图片描述的语速和效率有所提高。P02 的普通话图片描述包含显着更多以较慢语速产生的单词，而在她的英文描述中发现意义和效率显着提高。单词- P01 显示名词（仅限普通话）和动词（普通话和英语）的对抗命名准确性有所提高，而 P02 仅显示英语动词的准确性显着提高。

结论

两个讲普通话英语的 BWA 的 BCA 治疗复制了早期关于单语 PWA 的积极直接治疗效果的报告，特别是减少了阻碍对话成功的行为。此外，在语言不同的语言内部和跨语言的泛化为共享语言网络提供了证据，与 BWA 合作的临床医生可以利用这些网络。还讨论了文化、家庭背景、语言结构和认知缺陷对治疗结果的潜在影响。