Dosage and predictors of naming treatment response in aphasia

失语症治疗反应的剂量和预测因素

• 批准号: 8984834
• 负责人: Michael Walsh Dickey
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984834
• 关键词: Address; Affect; Ambulatory Care Facilities; Anterior; Aphasia; Area; Articulation Disorders; Attention; Basal Ganglia; Behavior; Behavior Therapy; Behavioral; Brain; Chronic; Clinical; Cognitive; Communities; Conflict (Psychology); Data; Decision Making; Disease; Dose; Economic Burden; Education; Elderly; Enrollment; Exhibits; Family; Healthcare; Healthcare Systems; Hippocampus (Brain); Hour; Impairment; Incidence; Individual; Language; Left; Lesion; Life; Linguistics; Location; MRI Scans; Magnetic Resonance Imaging; Measures; Memory; Modeling; Names; Neurologic; Outcome; Outcome Measure; Participant; Patients; Performance; Persons; Predictive Factor; Production; Psycholinguistics; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Resources; Role; Sampling; Semantics; Services; Societies; Stimulus; Stimulus Generalization; Stroke; Survivors; Testing; Time; To specify; Training; Treatment Effectiveness; Treatment outcome; United States; Value of Life; Variant; Veterans; Work; cognitive performance; cognitive testing; cost effective; design; dosage; effectiveness research; follow-up; improved; lexical; phonology; point of care; post stroke; predictive marker; prognostic; programs; psychosocial adjustment; public health relevance; relating to nervous system; response; standardize measure; success; time interval; treatment response

DESCRIPTION (provided by applicant): Language and communicative impairments following stroke (aphasia) affect more than 30% of stroke survivors, with an incidence of over 180,000 new cases annually. The consequences of aphasia are far reaching and can affect psychosocial adjustment, family role participation, vocational opportunities, and the ability to function independently in society. Recent estimates suggest that VHA outpatient clinics see 2000 new cases of aphasia each year, meaning that approximately 20,000 enrolled VHA patients and 100,000 United States Veterans are currently living with the condition. In response to this need, the VA Pittsburgh Healthcare System Geriatric Research, Education, and Clinical Center (GRECC) initiated the Program for Intensive Residential Aphasia Treatment and Education (PIRATE) in January 2009. PIRATE is a clinical demonstration project that provides approximately 100 hours of cognitive- linguistically oriented aphasia treatment to community dwelling Veterans over a 4-week period. PIRATE currently serves 18 Veterans per year in bi-monthly sessions. Resource limitations associated with PIRATE and aphasia treatment in general require that treatments be offered in the most cost-effective doses to those Veterans most likely to benefit from them. The proposed treatment-effectiveness research addresses these issues by examining the dose-response relationship for semantically-oriented naming treatment, and identifying cognitive, psycholinguistic and neuroanatomical predictors of treatment success. Study participants (n=50, over a 4-year period) will be recruited nationwide from Veterans enrolled in PIRATE. They will have their naming performance measured prior to PIRATE entry, during each week of treatment, and at program exit/follow-up. A battery of cognitive measures and structural magnetic resonance images of their brains will also be collected prior to treatment. Participants' performance on trained and untrained lexical items and a standardized measure of naming performance will be compared across time intervals to specify the therapy amounts for which maximum treatment benefits are achieved. Their treatment outcomes will also be correlated with specific cognitive test scores and the location and extent of their brain lesions to identify cognitive and neurological markers predictive of positive treatment response. Treatment response will also be compared across participants with different psycholinguistic profiles, to determine which groups of patients show greatest benefit from semantically-oriented naming treatment. The proposed research should provide answers to two interlocking questions: for whom is aphasia therapy most effective, and how much of it is needed to optimize treatment outcomes. These answers have the potential to set transformative new standards for how aphasia treatment is delivered within VHA. PUBLIC HEALTH RELEVANCE: Aphasia occurs in more than 30% of stroke survivors, including 100,000 United States Veterans, and can reduce participation in a wide range of valued life activities. This treatment- effectiveness study examines the dosages needed for positive response to treatment of naming impairments in aphasia, and cognitive and brain correlates of treatment success, within the context of the VA Pittsburgh Healthcare System's Program for Intensive Residential Aphasia Treatment and Education (PIRATE). Study participants' performance on standardized and treatment-related measures will be compared across 4 weeks of treatment, to specify the therapy amounts for which maximum benefits are achieved. Their treatment outcomes will also be correlated with measures of cognitive performance and the location and extent of their brain lesions to identify cognitive and neurological markers of positive treatment response.

描述(由申请人提供)： 中风后的语言和沟通障碍(失语症)影响着超过30%的中风幸存者，每年的新病例超过18万例。失语症的后果是深远的，可能会影响心理社会适应、家庭角色参与、职业机会和在社会中独立运作的能力。最近的估计表明，VHA门诊每年有2000例新的失语症病例，这意味着大约20,000名登记的VHA患者和100,000名美国退伍军人目前患有这种疾病。为了满足这一需求，弗吉尼亚州匹兹堡医疗保健系统老年研究、教育和临床中心(GRECC)于2009年1月启动了强化住宅性失语症治疗和教育计划(PIRATE)。PIPATE是一个临床示范项目，在四周的时间里为社区居住的退伍军人提供大约100个小时的认知语言失语症治疗。海盗目前每年为18名退伍军人提供两个月一次的服务。与海盗和失语症治疗有关的资源限制一般要求以最具成本效益的剂量向最有可能从中受益的退伍军人提供治疗。拟议的治疗效果研究通过检查面向语义的命名治疗的剂量-反应关系，并确定治疗成功的认知、心理语言学和神经解剖学预测因素来解决这些问题。研究参与者(n=50，为期4年)将在全国范围内从加入海盗的退伍军人中招募。他们将在海盗进入之前，在治疗的每一周，以及在程序退出/后续行动中测量他们的命名表现。在治疗之前，还将收集他们大脑的一系列认知测量和结构磁共振图像。参与者在训练和未训练的词汇项目上的表现以及命名成绩的标准化测量将在不同的时间间隔内进行比较，以确定获得最大治疗益处的治疗量。他们的治疗结果还将与特定的认知测试分数以及他们大脑病变的位置和程度相关联，以确定预测阳性治疗反应的认知和神经标志物。还将比较不同心理语言学特征的参与者的治疗反应，以确定哪些患者组从面向语义的命名治疗中受益最大。这项拟议的研究应该为两个相互关联的问题提供答案：对谁的失语症治疗最有效，以及需要多少治疗才能优化治疗结果。这些答案有可能为如何在VHA内提供失语症治疗设定变革性的新标准。 公共卫生相关性： 失语症发生在超过30%的中风幸存者身上，其中包括10万名美国退伍军人，并可能减少对各种有价值的生活活动的参与。这项治疗效果研究在VA匹兹堡医疗系统的强化住宅性失语症治疗和教育计划(PIRATE)的背景下，检查了失语症命名障碍治疗的积极反应所需的剂量，以及治疗成功的认知和大脑相关性。研究参与者在标准化和与治疗相关的措施方面的表现将在4周的治疗中进行比较，以明确实现最大益处的治疗量。他们的治疗结果还将与认知表现以及脑损伤的位置和程度相关联，以确定阳性治疗反应的认知和神经标记物。