論 文 公 開 資 料

類型:學位論文
研究生中文名:陳星潤
論文中文名稱:失語症命名損傷與提示效果之認知神經心理學探討
指導教授:曾進興 Chin-Hsing Tseng
學位類別:碩士
院校名稱:國立高雄師範大學
系所名稱:聽力學與語言治療研究所
畢業學年度:103
論文出版年:2015
學號:610159103
語文別:中文
論文頁數:117
關鍵詞:失語症, aphasia
論文中文摘要:本研究的目的為利用認知神經心理學的方法探討一位失語症患者其命名表現和提示效果,並推測其語言系統的損傷。本研究以一名有命名困難的失語症患者YH為對象,檢視其在一項圖片命名作業(實驗一)、四項認知神經心理學作業(實驗二)以及一項命名提示作業(實驗三)之表現。根據簡明失語症測驗結果,YH在口語表達為輕度損傷,且其口語表達錯誤主要以語音錯誤為主,然而個案和主要照護者皆表示YH在日常生活中有顯著的命名困難,且除了語音錯誤以外也經常出現其他類型的口語錯誤,例如語意錯誤和無法命名。
實驗一結果顯示YH有明顯的命名困難,且命名錯誤的類型包含語音錯誤、語意錯誤和無法命名,且隨著詞彙頻率越低或詞長越長,個案的命名正確率越低,顯示有詞頻效果和詞長效果,推測個案在語音輸出詞典和語音配置(phonological assembly)系統有損傷。
實驗二以詞彙圖片配對作業、同義詞判斷作業驗證語意系統之損傷;以非詞複誦和最小音素區辨作業驗證語音系統之損傷。結果顯示YH為多重的詞彙提取損傷,亦即其語意系統有輕度損傷,且為高層次的語意損傷;語音配置系統和聽覺語音分析系統則有廣泛性的損傷。
實驗三以語音和語意提示的方式,進一步檢視提示對命名錯誤的效果。整體來說,首字提示效果優於首音提示與語意提示。語音錯誤在提示後仍多維持語音錯誤,此結果反應YH的語音輸出損傷。語意錯誤則以首字提示效果最佳,而語意提示對於語意低相關錯誤效果較佳, 語音提示則對於語意高相關錯誤效果較佳。無法命名為首字提示和語意提示稍具效果,透過提示後的錯誤分布發現與語意錯誤有相似的型態,可能反應語意錯誤和無法命名有相似的損傷來源。提示作業結果支持實驗二結果,YH為多重詞彙提取損傷,而語音和語意提示在不同的錯誤類型具有不同的提示效果。
論文外文摘要:The current study adopted the cognitive neuropsychological approach to investigate naming deficits and cueing effects in an aphasic patient, YH, and base on the results to infer possible deficits in the language systems of the patient. Several tasks were conducted: a picture naming task (Experiment 1), four cognitive neuropsychological tasks (Experiment 2), and a naming and cueing task (Experiment 3). According to CCAT, YH showed mild naming deficits, and made primarily phonological errors. The results conflict with the statement of overt naming difficulties and various error types reported by YH and his significant other.
The results of the first experiment showed that YH had severe naming difficulties, and phonological errors, semantic errors, and omission were observed. The naming accuracy of YH was affected by word frequency and word length, suggesting breakdowns in phonological output lexicon and phonological assembly.
The second experiment included four cognitive neuropsychology tasks: word-to-picture matching, synonym judgments, non-word repetition, and non-word minimal pair discrimination. The results showed that there are multiple levels of breakdown in YH: the semantic system is mildly impaired; while deficits in phonological assembly and auditory phonological analysis are relatively severe.
The third experiment examined YH’s naming performance after cueing. Among all three cue types, the first syllable cue had the greatest cueing effects; no differences were found between the first sound cue and the semantic cue. Error analyses indicated that when phonological errors were observed in naming, the majority of responses after cueing still contained phonological errors. When target words were replaced with other words low in semantic relatedness, semantic cues were the best in eliciting correct naming. However, when target words were replaced with other semantically highly-related words, phonological cues worked better than semantic cues in eliciting correct responses. Cueing effects on omission were limited and similar pattern of error responses to semantic errors were observed, pointing to similar underlying source(s) of deficits of the two error types. Overall, the results of cueing task support that there might be multiple levels of breakdown in lexical retrieval in YH.
論文目次:目錄
中文摘要........................................................................................................................ ii
英文摘要...................................................................................................................... iii
目錄................................................................................................................................ v
表目錄.......................................................................................................................... vii
圖目錄........................................................................................................................ viii
第一章 緒論................................................................................................................ 1
第一節 研究背景與動機...................................................................................... 1
第二節 研究目的與問題...................................................................................... 4
第二章 文獻探討............................................................................ ............................ 5
第一節 詞彙提取.................................................................................................. 5
第二節 認知神經心理學.................................................................................... 14
第三節 命名治療法............................................................................................ 25
第三章 研究設計........................................................................................................ 33
第一節 研究對象................................................................................................ 33
第二節 研究流程................................................................................................ 38
第三節 研究材料................................................................................................ 40
第四節 資料分析與研究預期............................................................................ 41
第四章 實驗一:圖片命名作業 ............................................................................... 43
第一節 圖片命名作業........................................................................................ 43
第二節 詞彙頻率與詞彙長度分析.................................................................... 45
第三節 討論........................................................................................................ 47
第五章 實驗二:認知神經心理學作業 ................................................................... 49
第一節 語意作業................................................................................................ 49
vi
第二節 語音作業................................................................................................ 54
第三節 討論........................................................................................................ 59
第六章 實驗三:命名與提示作業 ........................................................................... 65
第一節 命名與提示作業.................................................................................... 65
第二節 命名錯誤與提示分析............................................................................ 68
第三節 討論........................................................................................................ 75
第七章 研究討論........................................................................................................ 80
第一節 綜合討論................................................................................................ 80
第二節 臨床意義................................................................................................ 92
第三節 研究限制和建議.................................................................................... 94
第四節 結論........................................................................................................ 96
參考文獻...................................................................................................................... 97
附錄............................................................................................................................ 109

表目錄
表3-1 YH於簡明失語症測驗-甲式的分數及百分等級 .......................................... 34
表4-1 YH在低頻、中頻和高頻圖片命名表現 ........................................................ 46
表4-2 YH在單音節、雙音節和多音節圖片命名表現 ............................................ 47
表5-1 YH在聽覺和視覺詞彙圖片配對作業結果 .................................................... 51
表5-2 YH在視覺和聽覺同義詞判斷作業表現 ........................................................ 54
表5-3 YH在非詞複誦作業表現 ................................................................................ 56
表5-4 YH在最小音素區辨作業結果 ........................................................................ 58
表5-5 YH在原語音作業和最舒適音量下語音作業的表現 .................................... 59
表5-6詞彙圖片配對作業的聽覺作業和視覺作業表現分析 .................................. 60
表5-7同義詞判斷作業的聽覺作業和視覺作業表現分析 ...................................... 61
表6-1實驗三提示組別安排 ...................................................................................... 65
表6-2 YH初始命名正確率和經提示後正確率 ........................................................ 68
表7-1個案1、個案2和YH在認知神經心理學作業表現 ................................... 85
表7-2個案SJ和YH在作業中的表現 ..................................................................... 87
表7-3個案SJ和YH命名表現的詞頻分析和詞長分析 ......................................... 88
表7-4個案WB和YH在三項分作業的表現 .......................................................... 89

圖目錄
圖2-1單字詞彙提取語言模組 .................................................................................. 16
圖2-2 PACA口語表達語言處理模組 ....................................................................... 21
圖2-3 六種提示在不同類型失語症的提示成效 ..................................................... 26
圖3-1YH的簡明失語症測驗結果剖面圖 ................................................................ 35
圖3-2 YH的語言特質分析剖面圖 ............................................................................ 35
圖3-3 YH純音聽力檢查結果 .................................................................................... 36
圖3-4研究流程圖 ...................................................................................................... 38
圖4-1圖片命名的語言歷程圖 .................................................................................. 43
圖4-2 YH在圖片命名作業不同錯誤類型比例 ........................................................ 45
圖5-1視覺和聽覺詞彙-圖片配對作業歷程 ............................................................. 49
圖5-2同義詞判斷作業的語言歷程圖 ...................................................................... 52
圖5-3非詞複誦作業語言歷程 .................................................................................. 55
圖5-4最小音素區辨作業語言歷程圖 ...................................................................... 57
圖6-1 YH在三次圖片命名與提示作業的正確率 .................................................... 67
圖6-2 YH在語音提示組、語意提示組和控制組初始命名錯誤分布 .................... 67
圖6-3 YH的語音錯誤、語意錯誤和無法命名經提示後正確率 ............................ 69
圖6-4 YH語音錯誤經各提示後的正確率 ................................................................ 70
圖6-5 YH的語音錯誤經各提示後的錯誤分布 ........................................................ 70
圖6-6 YH的語音錯誤經首音提示後的表現 ............................................................ 71
圖6-7 YH的語音錯誤經過首字提示的表現 ............................................................ 71
圖6-8 YH的語意錯誤在各提示下的正確率 ............................................................ 72
圖6-9 YH的語意錯誤經提示後的錯誤類型分布 .................................................... 72
圖6-10低相關錯誤、中相關錯誤和高相關錯誤經各提示後正確率 .................... 74
ix
圖6-11無法命名經由提示後正確率 ........................................................................ 75
圖6-12無法命名經提示後的錯誤類型分布 ............................................................ 75
圖6-13 YH的高相關錯誤經過提示後表現 .............................................................. 77
圖6-14 YH的低相關錯誤經提示後的表現 .............................................................. 78
圖6-15語意錯誤在提示後的錯誤分布、無法命名在提示後的錯誤分布 ............ 79
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