Developing an Evidence-Based Treatment Continuum for Spoken and Written Language

开发基于证据的口语和书面语言治疗连续体

• 批准号: 8132735
• 负责人: PELAGIE M BEESON
• 金额: $ 39.78万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8132735
• 关键词: Acquired Alexia; Address; Adult; Affect; Agraphia; Alexia; Algorithms; American; Aphasia; Behavior Therapy; Behavioral; Brain; Brain Injuries; Case Series; Characteristics; Clinical; Communication; Cues; Decision Making; Decision Trees; Diagnostic; Evaluation; Evidence based treatment; Failure; Family member; Future; Goals; Guidelines; Impairment; Individual; Intervention; Knowledge; Language; Language Disorders; Lesion; Link; Literature; Location; Modality; Oral; Orthography; Outcome; Participant; Pathologist; Patients; Performance; Phase; Procedures; Process; Protocols documentation; Reading; Recovery; Recovery of Function; Recruitment Activity; Rehabilitation therapy; Relative (related person); Research; Research Personnel; Research Project Grants; Residual state; Semantics; Sequential Treatment; Severities; Speech; Structure; System; Testing; Text; Therapeutic; Third-Party Payer; Training; Treatment outcome; Work; Writing; aphasia rehabilitation; cohort; design; improved; language processing; lexical; lexical retrieval; literate; novel; phonology; response; scaffold; skills training; stem; success; treatment planning

DESCRIPTION (provided by applicant): How can recovery from acquired language impairment be maximized? This question is central to the focus of every clinician and clinical researcher working with adults with aphasia, alexia, and agraphia. Nearly six decades of treatment research has yielded evidence supporting the efficacy of a wide range of language rehabilitation approaches. Unfortunately, the research efforts have been directed toward treatment approaches in isolation, and few, if any, researchers have considered the full scope and sequence of treatments necessary to maximize language recovery. In our current research, we tackled this issue with respect to the treatment of acquired agraphia, yielding evidence to support a treatment continuum for single-word writing. In the current proposal, we aim to build on the re-trained skills to maximize lexical retrieval in the spoken language modality, and to extend the treatment sequence to text-level reading and written composition. Our approach is novel in its focus on the interactive contribution of semantic, phonological, and orthographic processes. This perspective stems from evidence that literate adults have strongly established links among these three central language components, and the promotion of interactive processing of residual (and re-trained) skills in each domain can advance performance at multiple levels within the language system (sublexical, lexical, and sentence). We will examine a hierarchically structured treatment continuum where gaining mastery at a given level provides the scaffolding for advancing to the next level. A decision tree is proposed to guide the sequence for each individual in an algorithmic fashion. Using a case series approach, we propose to implement treatment with 50 individuals who reflect a diverse range of severity levels and behavioral and lesion profiles. Individual responses to treatment will be evaluated relative to performance on a comprehensive assessment of language before and after critical phases of treatment, allowing us to test the proposed algorithm. Language behavior and treatment outcomes will also be considered relative to the location and extent of brain damage affecting critical cortical networks. This work will advance the understanding of sequential treatment outcomes, and will serve to establish guidelines regarding treatment candidacy across the continuum. Ultimately, this study has the potential to change the way that clinicians plan treatment: shifting from the administration of isolated treatments to a planned sequence of interventions to maximize language recovery. PUBLIC HEALTH RELEVANCE: More than 1 million Americans have persistent acquired language impairment due to brain damage. The rehabilitation of spoken and written language impairments is a high priority for affected individuals, and the quality and efficiency of treatment approaches are critical issues for patients, family members, speech-language pathologists, and third-party payers. The research proposed here has the potential to significantly impact the planning and implementation of behavioral treatment in a manner that maximizes recovery of function.

描述（由申请人提供）：如何最大限度地恢复后天语言障碍？这个问题是每一个临床医生和临床研究人员与失语症，失读症和失写症的成年人一起工作的焦点。近六十年的治疗研究已经产生了证据，支持各种语言康复方法的功效。不幸的是，研究工作一直针对孤立的治疗方法，很少有研究人员考虑到最大限度地恢复语言所需的治疗范围和顺序。在我们目前的研究中，我们解决了这个问题，获得性失写症的治疗，产生的证据支持一个连续的治疗一个字的写作。在目前的建议中，我们的目标是建立在重新训练的技能，以最大限度地提高口语模态中的词汇检索，并将治疗序列扩展到文本层面的阅读和书面作文。我们的方法是新颖的，其重点是语义，语音和拼写过程的互动贡献。这一观点源于有证据表明，识字的成年人已经在这三个核心语言成分之间建立了牢固的联系，促进每个领域中剩余（和再培训）技能的互动处理可以在语言系统（亚词汇，词汇和句子）的多个层面上提高表现。我们将研究一个层次结构的治疗连续体，在给定的水平上获得掌握提供了前进到下一个水平的脚手架。提出了一种决策树，以算法的方式指导每个人的序列。使用病例系列的方法，我们建议实施治疗与50个人谁反映了不同的严重程度和行为和病变概况。个体对治疗的反应将相对于治疗关键阶段前后语言综合评估的表现进行评估，使我们能够测试所提出的算法。语言行为和治疗结果也将被认为是相对于影响关键皮层网络的脑损伤的位置和程度。这项工作将促进对序贯治疗结果的理解，并将有助于建立关于整个连续体治疗候选资格的指南。最终，这项研究有可能改变临床医生计划治疗的方式：从孤立治疗的管理转向有计划的干预序列，以最大限度地恢复语言。 公共卫生相关性：超过100万美国人因脑损伤而患有持续性后天语言障碍。口语和书面语言障碍的康复是受影响个体的高度优先事项，治疗方法的质量和效率是患者，家庭成员，语言病理学家和第三方支付者的关键问题。这里提出的研究有可能以最大限度地恢复功能的方式显着影响行为治疗的规划和实施。