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获得性语言障碍？这个问题是每个临床医生和临床研究人员与成人失语症、失读症和失写症一起工作的中心焦点。近60年的治疗研究已经提供了证据支持广泛的语言康复方法的有效性。不幸的是，研究工作一直是针对孤立的治疗方法，很少有研究人员考虑到最大限度地提高语言恢复所需的全部治疗范围和顺序。在我们目前的研究中，我们针对获得性失写症的治疗解决了这个问题，提供了支持单字书写连续治疗的证据。在当前的建议中，我们的目标是在重新训练的技能的基础上，最大限度地提高口语形式的词汇检索，并将处理顺序扩展到文本水平的阅读和书面写作。我们的方法是新颖的，因为它专注于语义、语音和正字法过程的相互作用。这一观点源于有证据表明，识字的成年人在这三个中心语言组成部分之间建立了强有力的联系，并且促进每个领域剩余（和重新训练）技能的互动处理可以提高语言系统（亚词汇、词汇和句子）的多个层面的表现。我们将研究一个分层结构的治疗连续体，其中在给定级别获得掌握提供了推进到下一个级别的脚手架。提出了一种决策树，以算法的方式指导每个个体的序列。采用病例系列方法，我们建议对50名反映不同严重程度、行为和病变概况的个体进行治疗。在治疗的关键阶段之前和之后，个体对治疗的反应将相对于语言的综合评估进行评估，使我们能够测试所提出的算法。语言行为和治疗结果也将考虑到影响关键皮质网络的脑损伤的位置和程度。这项工作将促进对顺序治疗结果的理解，并将有助于建立关于整个连续体治疗候选性的指导方针。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变为计划的干预序列，以最大限度地提高语言恢复。

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.