失語症の長期経過—外来訓練の意義

Long-term recovery from aphasia：The significance of speech therapy for outpatients with aphasia

　失語症状の長期経過を明らかにする研究の一環として，右手利き左大脳半球一側損傷後に失語症を呈した270例の病巣別回復経過と，その中で言語機能に低下を示した37症例のSLTA総合評価法得点各因子の機能変遷の既報告を俯瞰した．次に，2年以上適切な言語訓練を行った失語症121例について，SLTA総合評価法得点に影響を及ぼす要因を調査した．その結果，1)失語症状の回復は損傷部位や発症年齢によって経過は大きく異なるが，少なくとも6か月以上の長期にわたって回復を認める症例が多いこと，2)言語訓練後に回復を示した機能は脆弱である可能性が高いこと，3)発症年齢，Wernicke領野を含む上側頭回の病変の有無，発症3か月時SLTA総合評価法得点などが予後に重要な因子であること，が示唆された．

　以上のことから，失語症の訓練においては，1)長期にわたって変化しうる失語症状そのものに着目する必要があること，2)病院外来における訓練実施が望ましいこと，が考えられた．

　In conjunction with our study concerning the time-course analysis of language function in patients with aphasia, we made a broad examination of the following existing reports. We analyzed the long-term follow-up data of 270 right-handed aphasics with left unilateral damage based on the lesion site. We also studied 37 aphasic patients whose general scores on the Standard Language Test of Aphasia (SLTA), an indicator of functional recovery, declined over time, examining functional changes in the various factors affecting the scores. Furthermore, in 121 patients with aphasia who received cognitive-based linguistic rehabilitation for at least 2 years post-onset, we investigated factors that seemed to influence the general scores of SLTA. The results were as follows. 1) Depending on the lesion site and age at onset, recovery of aphasia symptoms greatly varies in its course;however, many aphasic patients show recovery over at least 6 months. 2) Functional restoration of language by therapy is rather fragile. 3) Age at onset, lesion in the left superior temporal gyrus including Wernicke's area, and baseline linguistic abilities including aphasia severity, and both phonological and semantic functions were significant predictors of long-term aphasia outcome. Based on these results, in aphasia rehabilitation it was considered that 1) it was necessary to pay attention to aphasia symptoms that could change over the long-term, and 2) it was desirable to conduct aphasia rehabilitation in hospitals for outpatients.