Adapting acceptance and mindfulness-based behavior therapy for stroke survivors with aphasia to improve communication success, post-stroke adaptation, and quality of life

1中风后失语症对健康相关质量有深远而持久的负面影响 生活的2。失语症是一种语言障碍，由后天脑损伤引起，影响30%-40%的 美国有3名中风幸存者和超过250万人。对于中风幸存者来说， 4失语症，他们对突然和意外的语言丧失的心理社会反应可以抑制或 5提高他们卒中后的适应和调整能力。目前迫切需要更好地 6解决失语症康复和康复中的心理社会因素。 7为满足这一需要，目前的试点项目力求调整接受和承诺 8结合语言补偿训练对卒中幸存者失语的治疗(ACT)。 ACT是一种旨在提高心理灵活性的行为干预，允许人们 10采取与他们的价值观一致的有意义的行动，即使是在情绪低落的情况下。 11 ACT是失语症的理想干预措施，因为它促进了更灵活的反应曲目， 12减少对语言交流的依赖，同时减少自我批评的判断和无益的想法 13道工序。此外，将ACT与语言补偿培训相结合将更多 14比它各部分的总和还多。语言补偿训练只有在泛化的情况下才有效 15到经常有压力的真实世界情况，而ACT只有在以下情况下才能对失语症患者开放 特意支持16种语言需求。然而，虽然ACT对中风幸存者有效 17和口吃的人，以前的工作没有调整ACT来满足特定的需求 18名失语症患者，从而排除了中风幸存者中一大批脆弱的人。 19本提案的目标是开发和完善失语症治疗的ACT 20以最大限度地提高中风患者的沟通参与度、心理社会适应能力和生活质量 21名失语症幸存者。目标1：与利益相关者咨询委员会合作制定 22并通过迭代设计过程完善失语治疗ACT手册。两个人- 23年顺序队列设计(n=21)将产生一个全面的、利益相关者驱动的 24行为治疗。目的2：确定干预的可行性和可接受性。可行性 25将通过遵守、招募、参与和完成情况进行评估。可接受性 26将通过客户满意度问卷-8进行评估。的初步效果大小 27沟通参与、心理社会适应和生活质量将为未来的临床试验提供信息。 28制定失语症ACT与NCMRR的范围和使命直接一致，因为它将 29使用行为干预来解决中风后生活的致残后果 30名失语者，从而更好地满足这一未得到充分服务的中风幸存者亚群的需求。

1 Post-stroke Aphasia has profound and lasting negative effects on health-related quality 2 of life. Aphasia is a language disorder caused by acquired brain injury that affects 30-40% of 3 stroke survivors and more than 2.5 million people in the United States. For stroke survivors with 4 aphasia, their psychosocial response to sudden and unexpected loss of language can inhibit or 5 promote their ability to adapt and adjust post stroke. There is currently a critical need to better 6 address psychosocial factors in aphasia rehabilitation and recovery. 7 To meet this need, the current pilot project seeks to adapt Acceptance and Commitment 8 Therapy (ACT) for stroke survivors with aphasia by integrating language compensation training. 9 ACT is a behavioral intervention designed to improve psychological flexibility, allowing people to 10 take meaningful action consistent with their values, even in the presence of emotional distress. 11 ACT is an ideal intervention for aphasia, as it promotes a more flexible response repertoire that 12 relies less on verbal communication while reducing self-critical judgments and unhelpful thought 13 processes. Furthermore, Integrating ACT and language compensation training will be more 14 than the sum of its parts. Language compensation training is only effective when generalized 15 to often stressful real-world situations while ACT is only accessible to people with aphasia if 16 language needs are deliberately supported. However, while ACT is effective for stroke survivors 17 and people who stutter, no prior work has adapted ACT to meet the specific needs of 18 people with aphasia, thereby excluding a large and vulnerable subset of stroke survivors. 19 The objective of this proposal is to develop and refine an ACT for Aphasia treatment designed 20 to maximize communication participation, psychosocial adjustment, and quality of life for stroke 21 survivors with aphasia. Aim 1: Collaborate with a Stakeholder Advisory Board to develop 22 and refine an ACT for Aphasia treatment manual via an iterative design process. A two- 23 year sequential cohort design (n=21) will result in a comprehensive, stakeholder-driven 24 behavioral treatment. Aim 2: Establish intervention feasibility and acceptability. Feasibility 25 will be assessed through adherence, recruitment, participation, and completion. Acceptability 26 will be assessed via the Client Satisfaction Questionnaire-8. Preliminary effect sizes for 27 communication participation, psychosocial adjustment, and QoL will inform future clinical trials. 28 Developing ACT for Aphasia is directly aligned with the scope and mission of NCMRR, as it will 29 use a behavioral intervention to addresses the disabling consequences of living with post-stroke 30 aphasia, thereby better meeting the needs of this underserved subgroup of stroke survivors.