Determinants of multilevel discourse outcomes in anomia treatment for aphasia

失语症贫血治疗中多层次话语结果的决定因素

• 批准号: 10314137
• 负责人: Robert Cavanaugh
• 金额: $ 3.42万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314137
• 关键词: Anomia; Aphasia; Archives; Attention; Bayesian Analysis; Brain Injuries; Clinical; Clinical effectiveness; Cognitive; Communication; Comparative Effectiveness Research; Cues; Development; Discourse analysis; Effectiveness; Enrollment; Episodic memory; Evaluation; Funding; Goals; Heterogeneity; Human; Impairment; Individual; Individual Differences; Influentials; Language; Language Disorders; Life; Linguistics; Measurement; Measures; Memory; Mentorship; Modeling; Motivation; Names; Outcome; Outcome Measure; Pattern; Performance; Probability; Research; Resolution; Retrieval; Risk; Role; Sampling; Scientist; Semantic memory; Semantics; Shoes; Structure; Training; Translational Research; Treatment outcome; United States; Validation; Walking; Work; base; career; clinical implementation; cognitive process; common treatment; disability; evidence base; executive function; follow-up; improved; lexical; multilevel analysis; phonology; psychosocial; response; restorative treatment; statistics; syntax; treatment effect

Communication is fundamental to the human condition but is impaired in life-altering ways for more than 2.4 million people with aphasia (PWA) in the United States.1 PWA identify discourse-level communication (i.e. language in use) as a high priority for treatment.2 The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse.3 However, treatment-related discourse outcomes are modest, poorly understood, and vary greatly between PWA.4,5 In response, this proposal will investigate mechanisms of action and cognitive predictors of multilevel discourse outcomes in Semantic Feature Analysis (SFA). While SFA is one of the most common treatments for aphasia,6–8 it is unclear how SFA improves discourse-level communication, and for whom.9 SFA improves word-level communication by (a) spreading activation across semantic networks,10 thus improving word-finding ability (restorative mechanism) and/or (b) training self-cueing and strategic responses to instances of anomia, thus improving language use (compensatory mechanism).11–13 Preliminary analysis found that intensive SFA improved the informativeness14 of discourse overall, and for 19/44 PWA (5I01RX000832-05, MPI: Dickey). However, informativeness alone cannot differentiate which mechanism(s) are responsible for discourse generalization in SFA. This study proposes a multilevel discourse analysis15,16 of archival discourse outcomes across two high- intensity SFA studies (5I01RX000832-05 and 1R01DC017475-01A1; combined n = 60). Multilevel discourse measures include: semantic and verbal paraphasias, predicate-argument structure, lexical diversity, informativeness, and global coherence.16,17 Aim 1 will evaluate the role of restorative and compensatory mechanisms on multilevel discourse outcomes. Patterns of correspondence and non-correspondence across discourse outcome measures will delineate the role of restorative and compensatory mechanisms in treatment-related discourse improvements. Aim 2 will examine cognitive predictors of multilevel discourse outcomes: semantic memory, episodic memory, attention, and executive function. Examining the relationships between cognitive factors and discourse outcome measures will establish how each cognitive process supports 1) restorative and/or compensatory mechanisms and 2) improvements at multiple levels of discourse. The proposed study has the potential to improve the clinical effectiveness and implementation of SFA by determining how and for whom SFA improves discourse-level communication. Ultimately, improving discourse- level communication may help to reduce the profound communication and psychosocial consequences of aphasia. This proposal will integrate training in discourse analysis, multivariate statistics, comparative effectiveness research, and professional development to accelerate the applicant’s independence as a clinician- scientist in pursuit of his long-term research goal: improving everyday communication outcomes via theoretically-grounded, translational research.

沟通对于人类状况至关重要，但在改变生活的方面受到损害超过 2.4 美国有 100 万失语症患者 (PWA)。1 PWA 确定话语层面的交流（即， 所使用的语言）作为治疗的高度优先事项。2大多数失语症治疗的核心前提是恢复 音素、单词和/或句子级别的语言将概括为话语。3 然而，与治疗相关的 话语结果一般，理解甚少，并且 PWA 之间差异很大。4,5 作为回应，该提案 将研究语义中多层次话语结果的行动机制和认知预测因素 特征分析（SFA）。虽然 SFA 是失语症最常见的治疗方法之一，6-8 但尚不清楚 SFA 如何发挥作用 改善话语层面的沟通，并为谁而改善。9 SFA 通过 (a) 改善词语层面的沟通 在语义网络中传播激活，10从而提高找词能力（恢复机制） 和/或 (b) 训练对失常情况的自我提示和战略反应，从而改善语言使用 （补偿机制）.11–13 初步分析发现，强化 SFA 提高了信息量 14 整体话语，以及 19/44 PWA（5I01RX000832-05，MPI：Dickey）。然而，仅靠信息性 无法区分哪些机制负责 SFA 中的话语泛化。 本研究提出了对两个高层次档案话语结果的多层次话语分析15,16 强度 SFA 研究（5I01RX000832-05 和 1R01DC017475-01A1；合并 n = 60）。多层次话语 衡量标准包括：语义和言语性失语、谓语-论证结构、词汇多样性、 信息性和全球一致性。16,17 目标 1 将评估恢复性和补偿性的作用 多层次对话结果的机制。对应和非对应的模式 跨话语成果衡量标准将描绘恢复性和补偿性机制的作用 治疗相关的话语改善。目标 2 将检查多层次话语的认知预测因素 结果：语义记忆、情景记忆、注意力和执行功能。检查关系 认知因素和话语结果测量之间的关系将确定每个认知过程如何支持 1) 恢复性和/或补偿机制；2) 多层次话语的改进。 拟议的研究有可能通过以下方式提高 SFA 的临床有效性和实施 确定 SFA 如何以及为谁改善话语层面的沟通。最终，改善话语—— 水平沟通可能有助于减少深刻的沟通和社会心理后果 失语症。该提案将整合话语分析、多元统计、比较等方面的培训 有效性研究和专业发展，以加速申请人作为临床医生的独立性 追求其长期研究目标的科学家：通过以下方式改善日常沟通结果 具有理论基础的转化研究。