失語症の呼称障害に対する意味セラピーの効果―訓練の主観的努力度に注目した単一事例研究

Effects of semantic therapy on picture-naming disorders in aphasia : A single case study on the degree of subjective effort

　重度の呼称障害を呈した失語症1例に対して，意味セラピーと音韻セラピーを実施し，その効果を単一事例研究デザインを用いて比較した．症例は64歳の右利き男性．左中大脳動脈領域の梗塞により重度ブローカ失語を呈し，標準失語症検査(SLTA)の呼称課題では正答はなかった．訓練では，音韻セラピーとして「呼称」「語頭音キューによる呼称」「復唱的音読」課題を，意味セラピーとして「音声単語と絵カードのマッチング」「文字単語と絵カードのマッチング」課題を行い，各訓練期中の呼称正答数を測定するとともに患者自身に努力度の評定を求めた．その結果，意味セラピーの呼称正答数の改善は音韻セラピーと同等であった．さらに，主観的努力度は意味セラピーでより低かった．効果が同等に得られるのであれば，努力度が低く心的負担が軽いと推測される意味セラピーのほうが訓練に適用しやすいと考えた．

　Semantic therapy and phonological therapy were performed for a case of aphasia with severe picture-naming disorders and the effects were compared in a single case research design.　The subject was a 64-year-old right-handed male who demonstrated severe Broca's aphasia following an occlusion in the left middle cerebral artery.　On the picture-naming subtest of the Standard Language Test of Aphasia (SLTA), he scored 0 out of 20.　We treated his naming disorders using tasks appropriate for phonological therapy and semantic therapy, and measured the number of correct picture-naming responses and the degree of subjective effort during each therapy session.　The phonological therapy tasks consisted of picture naming, providing an initial sound cue, and oral reading in repetition, and the semantic therapy tasks consisted of spoken word-to-picture matching and written word-to-picture matching.　The two types of therapy were equal in their magnitude of improvement.　However, the degree of subjective effort was lower for semantic therapy.　If the two types of therapy are equally effective, we think that semantic therapy, which may require less mental effort for the patients, should be more widely applied.