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

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有效性。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。

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.