Combined Aphasia and Robot-Assisted Arm Treatment for Chronic Stroke Survivors

项目摘要/摘要 在美国，中风是导致残疾的主要原因，经常导致语言和运动障碍 在专业、社交和家庭环境中造成参与障碍的损害。情态 康复方法将语言和运动领域的治疗分开，这有助于 中风康复的时间和费用。共同治疗的方法是可取的，以既加强治疗 效率和潜在的较低成本，但我们能够促进(而不是抑制)经济复苏的程度 通过跨领域的联合治疗还没有得到系统的探索。在这个项目中，我们 将针对失语的计算机化失语治疗整合到机器人辅助的上肢治疗中 同时保留每种治疗的关键方面。这项工作将为 我们是否可以通过单一的组合减少语言和运动领域的损害 治疗。我们的长期目标是为失语症的康复创造有效和高效的方法 同时患有语言和运动障碍的慢性中风患者通过综合治疗 传统上截然不同的康复领域。这项提议的中心假设是，我们可以减少 通过以保留每个领域的关键方面的方式组合治疗，从而在每个领域中造成损害。 这一中心假设将通过追求三个具体目标来检验：1)确定 失语症治疗与机器人辅助手臂治疗相结合可以改善儿童的语言结果 慢性卒中；2)确定失语症治疗与机器人辅助手臂治疗相结合 支持慢性中风患者的运动康复；3)探索将失语症治疗与机器人相结合- 辅助手臂治疗特别增强了对与手臂运动相关的词汇项的提取。 在前两个目标下，我们将直接测试联合治疗是否可以减少 每一个领域，都是朝着开发更大的II期临床试验迈出的关键一步。第三个探索性目标 测试基于手臂的康复与失语症治疗相结合是否特别增强记忆力 与手臂相关的词汇激活了未受损个体的运动皮质。拟议的研究 代表了在中风康复的更大背景下治疗失语症的一种创新方法， 结合语言和运动领域的治疗方法，促进慢性中风患者的康复。 这项拟议的研究意义重大，因为它测试了组合语言-运动的程度 治疗可以增强单词提取，同时它是否支持运动治疗。这两者结合在一起 治疗将构成第二阶段试验的基础，作为未来R01动力的一部分，以测试 综合治疗与传统方法相比。这条研究路线是基于综合治疗的 跨领域的研究有可能导致中风康复的范式转变。

PROJECT SUMMARY/ABSTRACT Stroke is a leading cause of disability in the United States, frequently leading to both language and motor impairment that creates barriers to participation in professional, social, and family settings. The modal approach to rehabilitation separates treatment in language and motor domains, which contributes to the time and expense of stroke recovery. Co-treatment approaches are desirable to both enhance treatment efficiency and potentially lower costs, but the extent to which we can promote (and not dampen) recovery by combining treatment across domains has not been systematically explored. In this project, we integrate a computerized aphasia therapy targeting anomia into robot-assisted upper-extremity treatment while preserving the critical aspects of each treatment. This work will provide a foundational test of whether we can reduce impairment in both language and motor domains with a single combined treatment. Our long-term goal is to create effective and efficient approaches to aphasia recovery in chronic stroke survivors with both language and motor deficits by combining treatment across these traditionally-distinct rehabilitation domains. The central hypothesis of this proposal is that we can reduce impairment in each domain by combining treatments in a manner that retains the critical aspects of each. This central hypothesis will be tested by pursuing three specific aims: 1) determine the whether combining aphasia treatment with robot-assisted arm treatment can improve language outcomes in chronic stroke; 2) determine whether combining aphasia treatment with robot-assisted arm treatment supports motor recovery in chronic stroke; 3) explore whether combining aphasia treatment with robot- assisted arm treatment specifically enhances retrieval of lexical items associated with arm movement. Under the first two aims, we will directly test whether the combined treatment can reduce impairment in each domain, a critical step towards developing a larger Phase II clinical trial. The third exploratory aim tests whether the combining arm-based rehabilitation with aphasia treatment specifically enhances recall of arm-related words that activate motor cortex in unimpaired individuals. The proposed research represents an innovative approach to aphasia treatment within the larger context of stroke rehabilitation, combining therapeutic methods across language and motor domains to promote recovery in chronic stroke. The proposed research is significant because it tests the extent to which a combined language-motor treatment can enhance word retrieval and simultaneously whether it supports motor treatment. This combined treatment will form the basis of a Phase II trial as part of a future R01 powered to test the effectiveness of combined treatment compared to traditional approaches. This line of research based on combining treatment across domains has the potential to lead to a paradigm shift in stroke rehabilitation.