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刻而持久的负面影响 2生活失语症是一种由后天性脑损伤引起的语言障碍， 3中风幸存者和超过250万人在美国。对于中风幸存者， 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.提高中风后的适应和调整能力。目前迫切需要更好地 6探讨失语症康复与恢复中的心理社会因素。 7为了满足这一需要，目前的试点项目试图调整接受和承诺 8通过整合语言补偿训练对中风幸存者失语症的治疗（ACT）。 9 ACT是一种行为干预，旨在提高心理灵活性， 10.即使在情绪困扰的情况下，也要采取与自己的价值观一致的有意义的行动。 11 ACT是治疗失语症的理想干预方法，因为它促进了更灵活的反应， 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个进程。此外，将ACT和语言补偿培训相结合， 14比它的部分的总和。语言补偿训练只有在推广时才有效 15到经常紧张的现实世界的情况下，而ACT是只有接触到失语症的人， 16种语言需求得到精心支持。然而，尽管ACT对中风幸存者有效， 17和口吃的人，没有以前的工作已经适应ACT，以满足特定的需要， 18名失语症患者，从而排除了大量脆弱的中风幸存者。 19本提案的目标是开发和完善用于失语症治疗的ACT， 20最大限度地提高中风患者的沟通参与、心理社会调整和生活质量 21名幸存者患有失语症目标1：与利益相关者咨询委员会合作， 22并通过迭代设计过程完善ACT失语症治疗手册。两个- 23年连续队列设计（n=21）将产生一个全面的，由股东驱动的 24行为治疗目标2：确定干预的可行性和可接受性。可行性 25人将通过依从性、招募、参与和完成进行评估。接受性 将通过客户满意度调查问卷-8对26人进行评估。初步效应量 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.开发用于失语症的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失语症，从而更好地满足这一服务不足的中风幸存者亚组的需求。

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.