Remediating narrative discourse impairments in veterans with TBI: Initial treatment development

修复患有 TBI 的退伍军人的叙事话语障碍：初步治疗开发

• 批准号: 10311590
• 负责人: Karen Le
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10311590
• 关键词: Address; Affect; Afghanistan; Aftercare; Anxiety; Area; Behavior Therapy; Case Study; Chronic; Cognition; Cognitive; Communication; Communication impairment; Comprehension; Computer Assisted; Data; Development; Diagnosis; Dimensions; Education; Educational process of instructing; Elements; Environment; Event; Funding; Future; Goals; Growth; Headache; Home; Impairment; Incidence; Individual; Intervention; Intervention Studies; Iraq; Knowledge; Language; Lead; Learning; Life; Linguistics; Literature; Loneliness; Manuals; Manuscripts; Measures; Mental Depression; Mental Health; Methodology; Methods; Modeling; Neurologic; Occupational; Outcome; Participant; Partner Communications; Peer Review; Persons; Phase; Post-Traumatic Stress Disorders; Preparation; Process; Protocols documentation; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reporting; Research; Research Personnel; Sample Size; Sampling; Secure; Severities; Social Interaction; Social isolation; Socialization; Stimulus; Structure; Symptoms; Time; Training; Traumatic Brain Injury; Treatment Protocols; Veterans; Work; Writing; base; behavioral clinical trial; career; comorbidity; daily functioning; design; efficacy evaluation; experience; feasibility trial; follow-up; improved; improved functioning; novel; remote delivery; satisfaction; scaffold; service member; skill acquisition; skills; skills training; social communication; social integration; social relationships; social skills; symposium; telehealth; telerehabilitation; therapy development; treatment adherence; treatment as usual; treatment effect; treatment group; wound

Cognitive-communication disorders are pervasive following TBI, disrupting communication at the level of discourse (meaningful language beyond sentence level) and social interaction. Discourse impairments impact functioning across major life domains. Research consistently shows that people with discourse impairments following TBI have difficulty securing and maintaining work, struggle with social relationships, experience social isolation, and report a decline in quality of life. Moreover, discourse impairments affect all severity levels of TBI and persist over time. The functional impact and chronicity of discourse impairments following TBI underscore the importance of treating these impairments. The overarching goal of this CDA-2 application is to prepare the candidate for a career in cognitive- communicative interventions research to address discourse impairments in TBI. The aims of the proposed project are to develop and trial a discourse treatment for veterans with TBI. Training goals for the project are to: 1) develop expertise in treatment development, 2) strengthen background in TBI-related comorbidities, 3) expand knowledge of telerehabilitation and computer-aided delivery, 4) develop expertise in conducting randomized clinical trials (RCTs) of behavioral interventions, including statistical and methodological approaches, and 5) further scientific writing, presentation skills, and grantsmanship. Narratives are a fundamental discourse genre embedded in daily conversation. Breakdowns at global levels of narrative discourse are a consistent finding in people with TBI and are apparent at the level of story content and story organization. Impairments in story content include deficiencies in completeness and accuracy of information, global coherence, and summarization. Impairments in story organization include reductions in story grammar elements, sequences of events (episodes) and proportion of the narrative organized by episodes. Discourse intervention in TBI is a nascent area of research, and, to date, there have been only a few studies that have attempted to improve discourse ability in TBI. These prior attempts have been small case studies, produced no change or limited gains, and did not include veterans with TBI. The proposed project is an early stage discourse treatment development study that will evaluate the feasibility of a novel narrative discourse treatment protocol that builds upon these prior attempts with an all-veteran participant sample. The first phase of the study will consist of initial manual development for the discourse treatment protocol and refinement with a small participant sample (5-10 participants). The protocol will incorporate elements from prior treatment studies that showed some promise: 1) hierarchical training, 2) variety of discourse stimuli, 3) development of skills and strategies for discourse processing, 4) structured training prompts, 5) meta-cognitive and meta-linguistic strategies, and 6) integration of learning principles. Novel treatment elements will include: 1) targeting both story content and story organization, 2) use of a discourse model to guide treatment, and 3) functional communication training. Treatment will be delivered twice a week over 8 weeks, with one in-person and one telehealth session each week. There will be four treatment phases: education, story organization, story content, and integration of story organization and content. The second phase will be a treatment feasibility trial on a separate sample of participants to obtain information regarding the tolerability, acceptability, and fidelity of the proposed discourse treatment and preliminary data on treatment delivery and assessment methods as well as preliminary information about treatment effects. Forty participants will be randomized to either the discourse treatment group or Treatment as Usual control. Assessments will be conducted at baseline, post-treatment, and at 1-month follow-up, and will include measures of discourse ability, cognition, mental health, functional communication and daily functioning.

认知沟通障碍在TBI后普遍存在，在沟通水平上中断。 语篇（超越句子层次的有意义的语言）和社会互动。话语障碍影响 在主要的生活领域发挥作用。研究一致表明，有话语障碍的人 TBI后难以获得和维持工作，与社会关系斗争，经历社交 隔离，并报告生活质量下降。此外，话语障碍影响所有严重程度的TBI 并持续一段时间TBI后话语障碍的功能影响和慢性化强调了 治疗这些损伤的重要性。 该CDA-2应用程序的总体目标是为候选人在认知领域的职业生涯做好准备。 沟通干预研究，以解决创伤性脑损伤的话语障碍。建议的目标 该项目旨在为TBI退伍军人开发和试验一种话语治疗。该项目的培训目标是 目的：1）发展治疗开发方面的专业知识，2）加强TBI相关合并症的背景知识，3） 扩大远程康复和计算机辅助交付的知识，4）发展进行 行为干预的随机临床试验（RCT），包括统计学和方法学 方法，和5）进一步的科学写作，演讲技巧，和granitarian。 叙事是日常会话中的一种基本语篇体裁。全球细分 叙述性话语的水平在TBI患者中是一致的发现，并且在故事水平上是明显的 内容和故事组织。故事内容的缺陷包括完整性的缺陷， 信息的准确性、全局一致性和总结。故事组织方面的缺陷包括 减少故事语法元素、事件序列（情节）和叙事比例 按情节组织。 TBI中的话语干预是一个新兴的研究领域，迄今为止，只有少数几个 这些研究试图提高TBI中的话语能力。这些先前的尝试都是小案件 研究，没有产生变化或有限的收益，并没有包括退伍军人与TBI。拟建项目 一个早期阶段的话语处理发展研究，将评估一个小说叙事的可行性 话语治疗协议，建立在这些先前的尝试与所有退伍军人参与者样本。 研究的第一阶段将包括话语处理协议的初始手动开发 和小参与者样本（5-10名参与者）的细化。该议定书将纳入以下内容： 先前的治疗研究显示了一些希望：1）分层训练，2）各种话语刺激，3） 发展语篇处理的技能和策略，4）结构化的训练提示，5）元认知 6）学习原则的整合。新型治疗元素将包括： 1)以故事内容和故事组织为目标，2）使用话语模式指导治疗，以及3） 功能性沟通培训。治疗将在8周内每周进行两次，其中一次是亲自进行的 每周一次远程医疗将有四个治疗阶段：教育，故事组织， 故事内容，以及故事组织和内容的集成。 第二阶段将是一个治疗可行性试验的一个单独的样本的参与者，以获得 关于拟议话语治疗的耐受性、可接受性和保真度的信息， 关于治疗提供和评估方法的初步数据，以及 治疗效果40名参与者将被随机分配到话语治疗组或 军事控制。将在基线、治疗后和1个月随访时进行评估， 包括话语能力、认知、心理健康、功能性沟通和日常功能。