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

1卒中后失语对健康相关质量有深远而持久的负面影响

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.