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

失语症是一种语言障碍，影响着大约200万美国人。与失语症相关的沟通障碍限制了重返工作和爱好的能力，恶化了社会关系，并导致社会孤立。社会孤立与许多负面的健康后果相关，包括死亡率。因此，失语症的后果可能是广泛而严重的。集体治疗有可能改善沟通，减少社会孤立，同时还可以降低医疗成本。然而，这种治疗形式缺乏强有力的证据基础。本研究使用假设驱动的方法来检验会话治疗的有效性，并开发和提炼了会话治疗如何导致沟通能力的行为变化的机制路径。我们将系统地探索治疗效果是否会因参与者的数量(大组或二联体)、组组成(失语症的异质性与同质性)和失语症的严重程度而不同。这项研究将在三个地点招募168名失语症参与者。在第一周期中，72名参与者将被随机分配到三种情况之一：DYAD治疗、传统组治疗或延迟控制组。在第二周期和第三周期中，48名重度失语症患者和48名轻-中度失语症患者将被随机分配到大组或二重组。在所有周期中，治疗将进行60分钟，每周两次，为期10周。在治疗过程中，言语病理学家将利用个性化、语言学和多模式线索层次结构，促进对一组突出主题的集中讨论，如时事。主要结果测量是沟通的功能测量(失语症交流结果测量，ACOM；Hula等人，2015)。次级结果测量将包括标准化测试和患者报告结果测量，并检查语言和功能沟通能力。所有参与者将在治疗前、治疗后、治疗后4周和治疗后12周进行评估。拟议的研究将涉及以下具体目标。具体目标1是检查在二元组和大组中实施的对话治疗与延迟治疗对照组的疗效。具体目标2是通过测试治疗效果是否随着失语症严重程度(2A)或群体组成(2B)的不同而不同，从而确定会话治疗的最佳参数。《特定目标3》将测试谈话治疗影响行为改变的一个假想模型。该结果将为SAVERS治疗提供进一步的疗效，并告知该干预的最佳参数和结果。这项工作迈出了至关重要的第一步，旨在阐明对话小组治疗中的变化机制，长期目标是确保失语症患者获得具有成本效益的护理。

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.