Understanding the Mechanisms of Change and Optimal Parameters in Conversation Treatment for Aphasia

了解失语症对话治疗的变化机制和最佳参数

• 批准号: 10207326
• 负责人: GAYLE L DEDE
• 金额: $ 69.01万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10207326
• 关键词: Address; Affect; Aftercare; American; Americas; Aphasia; Behavior; Behavioral; Caring; Clinical; Clinical Trials; Communication; Communication Barriers; Communication impairment; Control Groups; Cues; Data; Enrollment; Ensure; Event; Future; Goals; Health; Health Services Accessibility; Hobbies; Impairment; Individual; Intervention; Knowledge; Language; Language Disorders; Lead; Learning; Life; Linguistics; Logic; Maps; Measurable; Measures; Medical Care Costs; Modeling; Names; Outcome; Outcome Measure; Participant; Pathway interactions; Patient Outcomes Assessments; Patient Self-Report; Performance; Persons; Phase; Psychosocial Assessment and Care; Psychosocial Factor; Randomized; Randomized Controlled Clinical Trials; Research; Resources; Risk; Sampling; Service delivery model; Severities; Site; Social isolation; Speech Pathologist; Standardization; Testing; Treatment Efficacy; Treatment outcome; Variant; Work; base; cost effective; dosage; efficacy evaluation; efficacy testing; evidence base; improved; member; mortality; multimodality; primary outcome; programs; secondary outcome; skills; social relationships; treatment effect; treatment group; treatment research

Aphasia is a language disorder that affects approximately two million Americans. The communication barriers associated with aphasia limit the ability to return to work and hobbies, worsen social relationships, and lead to social isolation. Social isolation is correlated with many negative health outcomes, including mortality. As a result, the consequences of aphasia can be wide reaching and severe. Group treatment has the potential to improve communication and reduce social isolation, while also reducing medical costs. However, this treatment format lacks a strong evidence base. This research uses a hypothesis-driven approach to test the efficacy of conversation treatment and develop and refine a mechanistic pathway of how conversation treatment leads to behavioral changes in communication ability. We will systematically explore whether the effects of treatment differ as a result of number of participants (large group or dyad), group composition (heterogenous versus homogenous profiles of aphasia), and severity of aphasia. The study will enroll a total of 168 participants with aphasia across three sites. In cycle one, 72 participants will be randomly assigned to one of three conditions: dyad treatment, traditional group treatment or delayed control group. In cycles two and three, 48 participants with severe aphasia and 48 participants with mild-moderate aphasia will be randomly assigned to either large group or dyad conditions. In all cycles, treatment will occur for 60 minutes, twice per week for 10 weeks. During treatment sessions, a speech pathologist will facilitate discourse on a focused set of salient topics, such as current events, using individualized, linguistic and multimodal cueing hierarchies. The primary outcome measure is a functional measure of communication (Aphasia Communication Outcome Measure, ACOM; Hula et al., 2015). Secondary outcome measures will include standardized tests and patient reported outcome measures, and examine linguistic and functional communication abilities. All participants will be assessed pre-, post-, 4 weeks post- and 12 weeks post-treatment. The proposed research will address the following specific aims. Specific Aim 1 is to examine efficacy of conversation treatment delivered in dyads and large groups compared to a delayed-treatment control group. Specific Aim 2 is to determine optimal parameters for conversation treatment by testing whether the treatment effects differ as a function of aphasia severity (2A) or group composition (2B). Specific Aim 3 will test a hypothesized model of the pathway by which conversation treatment effects behavioral change. The results will provide further efficacy for conversation treatment and inform about the optimal parameters and outcomes of this intervention. This work takes a vital first step towards elucidating the mechanisms of change in conversation group treatment, with a long-term goal of ensuring access to cost-effective care for people with aphasia.

失语症是一种影响大约200万美国人的语言障碍。与失语有关的沟通障碍限制了重返工作和爱好，恶化社会关系并导致社会隔离的能力。社会隔离与许多负面的健康结果（包括死亡率）相关。结果，失语症的后果可能是广泛的，严重的。小组治疗有可能改善沟通并减少社会隔离，同时降低医疗成本。但是，这种治疗形式缺乏强大的证据基础。这项研究使用一种假设驱动的方法来测试对话处理的功效，并发展和完善对话处理如何导致沟通能力行为变化的机理途径。我们将系统地探讨治疗的影响是否因参与者（大组或二元组），组组成（异体与同质性疾病的均匀概况）以及失语性的严重性而导致的影响是否有所不同。这项研究将在三个地点招募共有168名参与者。在第一个周期中，将将72名参与者随机分配到三个条件之一：二元治疗，传统小组治疗或延迟对照组。在第二和第三个周期中，有48名严重失语症的参与者和48名轻度中度失语症的参与者将随机分配给大组或二元状况。在所有周期中，治疗将进行60分钟，每周两次，持续10周。在治疗课程中，言语病理学家将使用个性化，语言和多模式提示层次结构来促进一系列重点的显着主题（例如时事）的讨论。主要结果度量是通信的功能衡量标准（失语症交流结果，ACOM； Hula等，2015）。次要结果指标将包括标准化测试和患者报告的结果指标，并检查语言和功能沟通能力。治疗后，所有参与者将在治疗后，后，4周和12周评估。拟议的研究将解决以下特定目标。具体目的1是检查与延迟治疗对照组相比，在二元组和大组中提供的对话处理的功效。特定目的2是通过测试治疗效果是否因失语症严重程度（2a）还是组组成（2B）来确定对话处理的最佳参数。特定的目标3将测试途径的假设模型，通过该模型会影响行为改变。结果将为对话处理提供进一步的功效，并告知此干预措施的最佳参数和结果。这项工作迈出了至关重要的第一步，以阐明对话组治疗的变化机制，其长期目标是确保失语症患者获得具有成本效益的护理。