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Compreens?o de texto escrito e oral e correlatados neurais na les?o de hemisf?rio esquerdo p?s acidente vascular cerebralMartins, Sabrine Amaral 28 March 2018 (has links)
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Previous issue date: 2018-03-28 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Written and oral text comprehension abilities are indispensable for human experiences. Strokes causing left hemisphere (LH) damage may impact comprehension and textual production. However, little is known about this influence at the textual/discursive level, including the comparison between oral and written modalities in this kind of lesion. This research aimed at investigating text comprehension in two modalities of presentation (read and heard) by left brain damaged individuals (LBD) and healthy controls, comparing their performance in the micro- and macro-structural levels of text comprehension to neuropsychological data and to density of the brain areas involved. In order to do that, we performed two researches, Study 1, with 18 LBD and 10 controls, and Study 2, with 10 LBD and 10 controls, with matched age and education. In both studies, neuropsychological tests assessed working memory, verbal fluency and naming abilities. Comprehension of macro- and microstructural levels was verified by means of six short narratives, presented in oral or written modality. The participants were asked to retell the stories and answer to five interpretation questions. In Study 2, the same method was used, but it included structural magnetic resonance imaging indicating the density of brain regions by voxel-based morphometry (VBM). The results of Study 1 indicated significant differences in narrative comprehension between LBD and controls. The lower performance observed at the macrostructural level of LBD compared to the micro- suggest individuals who had a stroke may face difficulties in the application of macrorules of deletion, construction and generalization, which underlie overall comprehension of a text. The data from Study 2, with a lower number of participants, indicated a tendency to confirm results found in Study 1, with statistical significant differences in benefit of controls at the macrostructural level of oral narratives. We found significant differences between groups regarding the modality of text presentation. In both Study 1 and Study 2, differences were observed between the groups in auditory word span and in naming, with an advantage to controls. The morphometry data of brain regions, related to the participants of Study 2, indicated an integration of areas from left and right hemispheres to process text comprehension in oral and written modalities. In the left hemisphere, precuneus, cerebellum white matter, superior frontal region and medial orbitofrontal region and from the right hemisphere, accumbens and superior temporal sulcus were observed. The right superior temporal sulcus, left precuneus, left cerebellar white matter and superior frontal region are positively correlated among the participants, presenting better performance as the density increases. The left medial orbitofrontal region shows a negative correlation with comprehension. The right accumbens seems to compensate LH demands, showing increased density in the LBD and reduced volume in the controls. The present study intends to contribute to deepen our understanding of the comprehension of texts presented in the oral compared to written modality in the LH lesion, related to neuropsychological and brain data. / Compreender um texto, seja ele ouvido ou lido, ? indispens?vel para as experi?ncias humanas. Acidentes vasculares cerebrais (AVCs) ocorridos em especial no hemisf?rio esquerdo (HE) podem impactar na compreens?o e na produ??o textual. No entanto, pouco ainda se sabe sobre essa influ?ncia no n?vel textual/discursivo, incluindo, por exemplo, a compara??o entre a modalidade oral e escrita na compreens?o textual/discursiva nesse tipo de les?o. Esta pesquisa teve por objetivo investigar a compreens?o de narrativas em duas modalidades de apresenta??o (lidas e ouvidas) por indiv?duos com les?o no hemisf?rio esquerdo (LHE) e controles saud?veis, comparando-se seu desempenho nos n?veis micro- e macroestruturais da compreens?o de narrativas a dados neuropsicol?gicos e ? densidade das ?reas cerebrais implicadas. Para tal, realizamos dois estudos, o Estudo 1, com 18 LHE e 10 controles, e o Estudo 2, que contemplou exames de neuroimagem, com 10 LHE e 10 controles (os mesmos do Estudo 1), com idade e escolaridade equiparadas. Em ambos os estudos, testes neuropsicol?gicos avaliaram a mem?ria de trabalho, a flu?ncia verbal e a nomea??o. A compreens?o dos n?veis macro- e microestrutural foi verificada por meio de seis narrativas curtas, divididas na modalidade oral ou escrita. Os participantes realizavam um reconto e respondiam a cinco perguntas de interpreta??o. No Estudo 2 empregou-se o mesmo m?todo, por?m com inclus?o de exame de resson?ncia magn?tica estrutural indicando a densidade das regi?es cerebrais pela morfometria baseada em voxels (VBM). Os resultados do Estudo 1 apontaram diferen?as significativas na compreens?o de narrativas entre LHE e controles. Os preju?zos observados no n?vel macroestrutural dos LHE em detrimento do micro- sugerem falhas na aplica??o das macrorregras de dele??o, constru??o e generaliza??o, subjacentes ? compreens?o global de um texto. Os dados do Estudo 2, com menor n?mero de participantes, indicaram uma tend?ncia a corroborar os resultados encontrados no Estudo 1, observando-se diferen?a significativa em benef?cio dos controles no n?vel macroestrutural das narrativas apresentadas oralmente. Foram encontradas diferen?as entre os grupos quanto ? modalidade de apresenta??o dos textos. Tanto no Estudo 1 quanto no Estudo 2 observou-se diferen?as no span auditivo de palavras e na nomea??o, com vantagem para os controles. Os dados da morfometria das regi?es cerebrais, atinentes aos participantes do segundo estudo, apontam uma integra??o de regi?es do hemisf?rio esquerdo e do direito. Do esquerdo, prec?neus, subst?ncia branca do cerebelo, regi?o frontal superior e regi?o orbitofrontal medial e do direito, accumbens e sulco temporal superior foram observadas. O sulco temporal superior direito, o prec?neus esquerdo, a subst?ncia branca cerebelar esquerda e a regi?o frontal superior correlacionam-se positivamente entre os participantes, apresentando desempenho superior ? medida que a densidade aumenta. A regi?o orbitofrontal medial esquerda apresenta correla??o negativa com a compreens?o. A regi?o do accumbens direito parece compensar as demandas do HE, apresentando sua densidade aumentada nos LHE e reduzida nos controles. O presente estudo pretende contribuir para aprofundarmos nossa compreens?o sobre a compreens?o de narrativas apresentadas na modalidade oral versus escrita na les?o de HE, relacionados a dados neuropsicol?gicos e cerebrais.
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