Determinants of multilevel discourse outcomes in anomia treatment for aphasia

沟通是人类生存的基础，但在2.4年以上的时间里， 在美国，有100万失语症（PWA）患者。1 PWA识别话语水平的沟通（即， 大多数失语症治疗的中心前提是， 音素、单词和/或句子水平的语言将概括为话语。3然而， 话语结果是温和的，不太了解，PWA之间差异很大。 将探讨语义学中多层次话语结果的作用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，但6-8目前尚不清楚SFA如何治疗失语症。 提高语篇层面的沟通，并为whom.9 SFA提高单词层面的沟通（a） 在语义网络中传播激活，10从而提高单词查找能力（恢复机制） 和/或（B）训练对失范实例的自我提示和策略反应，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 总体话语和19/44 PWA（5I 01 RX 000832 -05，MPI：Dickey）。然而，信息本身 不能区分在SFA中哪些机制负责语篇概括。 这项研究提出了一个多层次的话语分析15，16档案话语结果在两个高- 强度SFA研究（5I 01 RX 000832 -05和1 R 01 DC 017475 - 01 A1;合并n = 60）。多层次话语 测量包括：语义和言语的失语症，谓词论元结构，词汇多样性， 16，17目标1将评估恢复性和补偿性的作用， 多层次话语结果的机制。对应与非对应模式 跨话语结果的措施将描绘恢复和补偿机制的作用， 治疗相关的话语改善。目标2将考察多层次语篇的认知预测因素 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)恢复和/或补偿机制; 2）在多个层面的话语改进。 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如何以及为谁改善语篇层面的沟通。最后，改善话语- 水平沟通可能有助于减少深刻的沟通和心理社会后果， 失语症该建议将整合话语分析，多元统计，比较 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- 科学家追求他的长期研究目标：通过 有理论基础的转化研究

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.