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: 8411996
• 负责人: PELAGIE M BEESON
• 金额: $ 37.77万
• 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/8411996
• 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; public health relevance; 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.

描述（由申请人提供）：如何最大程度地从后天语言障碍中恢复？这个问题是每位治疗失语症、失读症和失写症成人的临床医生和临床研究人员关注的焦点。近六十年的治疗研究已经产生了支持多种语言康复方法有效性的证据。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过最大化语言恢复所需的治疗的全部范围和顺序。在我们目前的研究中，我们解决了有关获得性失写症治疗的问题，提供了支持单字写作治疗连续体的证据。在当前的提案中，我们的目标是建立在再培训技能的基础上，最大限度地提高口语模态中的词汇检索，并将处理序列扩展到文本级阅读和书面写作。我们的方法新颖之处在于它关注语义、语音和拼写过程的交互贡献。这一观点源于有证据表明，识字的成年人在这三个核心语言组成部分之间建立了牢固的联系，并且促进每个领域中残留（和再训练）技能的交互处理可以提高语言系统内多个层面（词汇下、词汇和句子）的表现。我们将研究一个分层结构的治疗连续体，其中在给定级别上的掌握为进入下一个级别提供了基础。提出了决策树以算法方式指导每个个体的序列。我们建议采用病例系列方法对 50 名反映不同严重程度、行为和病变特征的个体进行治疗。个人对治疗的反应将根据治疗关键阶段前后语言综合评估的表现进行评估，从而使我们能够测试所提出的算法。语言行为和治疗结果也将根据影响关键皮层网络的脑损伤的位置和程度来考虑。这项工作将增进对序贯治疗结果的理解，并将有助于建立有关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：从单独的治疗转向有计划的干预措施序列，以最大限度地恢复语言。