Treatment of agrammatism in oral and written production in patients with Broca’s aphasia The use of implicit and explicit learning

Abstract. Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. Objective: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca’s aphasia. Methods: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. Results: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. Conclusion: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production.

摘要：目前针对语法缺失（agrammatism）的康复干预存在多种方案，均基于内隐学习与外显学习两种范式开展。本研究旨在验证适配版映射疗法（Mapping Therapy）与失语症语言口语阅读疗法（ORLA，Oral Reading for Language in Aphasia）——分别对应外显学习与内隐学习——对布洛卡失语症（Broca’s aphasia）伴语法缺失患者的自发语言口语及书面语产出的影响。研究方法：本研究纳入6名受试者，分别接受映射疗法与ORLA治疗；通过图片描述任务采集受试者的口语与书面语产出样本，对比治疗前后的样本表现。研究结果：在映射疗法组中，受试者训练后与书面语产出相关的各项指标均显著提升，包括词汇总数、名词、动词、封闭类词（closed-class words）及完整句数量；而就口语输出而言，受试者治疗前后的表现无明显差异。在ORLA组中，受试者在与口语产出相关的各项指标上呈现出治疗前后的显著差异：词汇数量、动词数量及言语速率均有所提高；但其书面语产出的治疗前后表现则无显著差异。研究结论：内隐学习与外显学习均可应用于语法缺失的康复治疗。其中，映射疗法对改善语法缺失患者的书面语产出更为有效，而ORLA则更适用于改善该类患者的口语产出。