Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia

中风对幸存者及其照顾者的健康和生活质量造成重大负担， 就医疗成本和生产力损失而言，这是一个重大的公共卫生问题。失语症增加了中风的成本- 相关护理许多患有失语症的中风幸存者在住院康复机构接受治疗。然而，在这方面， 失语症的恢复是可变的，并且关于住院康复对结果的益处的证据有限。 本研究的目的是描述语言、认知-交际和健康相关的轨迹 卒中后失语症患者在住院和门诊康复期间的生活质量（QoL）结果 中风后18个月。招募了300例脑卒中失语症患者 在三个中西部康复医院将完成语言和认知沟通的措施， 性能和神经疾病生活质量（Neuro-QoL）测量系统工具 在康复期间和中风后6个月、12个月和18个月。我们将模拟个人和团体的结果 轨迹，使我们能够制定个人预测，这可以为临床规划和决策提供信息， 对于新患者。具体目标是： 目的1：建立一个脑卒中失语症患者的前瞻性队列，并确定其典型的线性运动轨迹。 IRF入院和出院时的言语、认知-沟通和健康相关QoL恢复， 以及发病后6、12和18个月。 目的2：确定与语言、认知-沟通和健康相关的生活质量相关的因素， 来自以下方面：患者因素，包括人口统计学和临床特征， 中风和失语症;治疗变量，包括住院和门诊失语症治疗特征， 非正式失语症服务;和生物标志物，包括遗传和神经影像学生物标志物。 目的3：评估语言、认知-沟通和健康相关生活质量模型的稳定性， 是从目标1和2发展而来的恢复。 本研究在使用（1）标准化评估方面具有创新性，不仅测量语言结果， 也沟通和生活质量的结果;（2）以患者为中心，自我报告的工具，如神经生活质量， 脑卒中后18个月内tect临床重要变化;（3）个体生长曲线分析，以描述 恢复轨迹，并检查人口统计学，病变，失语症，遗传和言语之间的关联， 语言治疗特征;（4）与促进神经可塑性有关的生物标志物;（5）休息- 功能性磁共振成像评估网络病理学与 失语症的恢复;（6）临床上提供的失语症治疗的类型、数量和持续时间的信息 （7）正式治疗后出院后的非正式失语症服务信息。

Stroke imposes significant burdens on the health and quality of life of survivors and their caregivers, and presents a major public health issue in terms of healthcare costs and lost productivity. Aphasia adds to the cost of stroke- related care. Many stroke survivors with aphasia receive therapy in inpatient rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of inpatient rehabilitation on outcomes. The objective of this study is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (QoL) outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilita- tion to 18 months following stroke. A sampleof 300 consecutively-admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological Disorders (Neuro-QoL) Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We will model outcomes as individual and group trajectories, allowing us to develop individual predictions which could inform clinical planning and decision-mak- ing for new patients. The Specific Aims are to: Aim 1: Establish a prospective cohort of stroke patients with aphasia, and define their typical trajectory of lin- guistic, cognitive-communicative, and health-related QoL recovery at admission to and discharge from the IRF, and at 6, 12, and 18 months post onset. Aim 2: Identify factors that are associated with linguistic, cognitive-communicative, and health-related QoL out- comes from among the following: patient factors including demographic and clinical characteristics related to stroke and aphasia; treatment variables including inpatient and outpatient aphasia therapy characteristics and informal aphasia services; and biomarkers, including genetic and neuroimaging biomarkers. Aim 3: Evaluate the stability of the models of linguistic, cognitive-communicative, and health-related QoL out- comes recovery that are developed from Aims 1 and 2. This study is innovative in its use of (1) standardized assessments that measure not only linguistic outcomes but also communication and QoL outcomes; (2) patient-centered, self-report instruments such as Neuro-QoL to de- tect clinically important change through 18 months post-stroke; (3) individual growth curve analysis to describe recovery trajectories and examine associations between demographic, lesion, aphasia, genetic, and speech and language therapy characteristics; (4) biomarkers that have been implicated in promoting neuroplasticity; (5) rest- ing state functional magnetic resonance imaging to evaluate the association between network pathology and recovery from aphasia; (6) information on type, amount, and duration of aphasia treatment provided in clinical settings; and (7) information on informal aphasia services following discharge from formal therapy.