Aphasia Rehabilitation: Modulating Cues, Feedback & Practice

描述（由申请人提供）：很少有研究系统地研究了失语症治疗过程中固有的理论驱动变量的影响，无论具体的治疗方法如何。此外，最近强调需要强化失语症治疗，以使长期的神经可塑性变化与恢复和康复后中风导致的概念，“更多”的治疗是更好的。然而，关于有效的实践分布和调度的具体信息是有限的。本建议的目的是进行一系列的干预研究，以检查不同的治疗变量和实践条件如何影响短期收购和长期维护和推广的技能在慢性失语症的康复。这是最好的实现，通过使用一个单一的治疗模式，有实验支持其疗效，其中包括变量的操作，如提示和反馈，并具有容易观察和测量的结果。选择的治疗，失语症失语症，是在一个高度控制的计算机环境（网络，PC，平板电脑）由拟人准确的“数字”治疗师，能够可视化建模语音和交互式指导治疗，从而确保治疗的独立性和保真度，通过消除临床医生相关的变量，如临床医生的专业知识和个性因素，可能影响治疗结果。首先，本研究将进行一项交叉研究，以测量线索对脚本训练的获得、维持和概括的影响。受试者将被随机分配到减少错误条件或错误条件。第二，为了测量外显自我监控训练和任务复杂性对脚本训练的获得、维持和概括的影响，受试者将被随机分配到四种条件之一，这四种条件因反馈（无反馈与自我反馈）和脚本复杂性（高复杂性与低复杂性）而异。初步研究结果将用于修改现有的失语症治疗计划。第三，将使用修改后的失语症训练计划评估练习分布和时间表对脚本训练的获得、维持和概括的影响。受试者将被随机分配到四种条件之一，这些条件因练习时间表（分组与随机）和练习分布（集中与分散）而异。主要结果指标是产生的脚本相关的单词的百分比;次要结果指标包括脚本相关的单词的比率和语法生产力的措施。结果和计算模型的收购，维护和推广将提供新的证据，以支持不仅是疗效和交付的失语症治疗，但也适用于实践原则失语症治疗一般。

DESCRIPTION (provided by applicant): Few studies have systematically investigated the effects of theory-driven variables that are inherent to the aphasia treatment process, regardless of the specific treatment approach. Furthermore, recent emphasis on the need for intensive aphasia treatment in order to make the long-term neuroplastic changes associated with recovery and rehabilitation following a stroke has led to the notion that "more" treatment is better. Yet, specific information regarding effective practice distributions and scheduling is limited. The purpose of this proposal is to conduct a series of intervention studies to examine how different treatment variables and practice conditions affect short-term acquisition and long-term maintenance and generalization of a skill in the rehabilitation of chronic aphasia. This is best accomplished by using a single treatment paradigm that has experimental support regarding its efficacy, which accommodates the manipulation of variables such as cueing and feedback, and which has easily observable and measurable outcomes. The selected treatment, Aphasia Scripts, is delivered in a highly controlled computer environment (web, PC, tablet) by an anthropomorphically accurate "digital" therapist, capable of visually modeling speech and interactively guiding treatment, thereby ensuring treatment independence and fidelity by removing clinician-related variables such as clinician expertise and personality factors that potentially influence treatment outcomes. First, a cross-over study will be conducted to measure the effect of cues on acquisition, maintenance and generalization of script training. Participants will be randomized to an error-reducing condition or an errorful condition. Second, to measure the effect of explicit self-monitoring training and task complexity on acquisition, maintenance and generalization of script training, subjects will be randomly assigned to one of four conditions, that vary by feedback (no feedback versus self-feedback) and script complexity (high versus low complexity). Preliminary findings will be used to modify the existing Aphasia Scripts program. Third, the effect of practice distribution and schedules on acquisition, maintenance and generalization of script training will be assessed using the modified Aphasia Scripts program. Subjects will be randomly assigned to one of four conditions that vary by practice schedule (blocked versus random) and practice distribution (massed versus distributed). The primary outcome measure is the percent of script-related words produced; secondary outcome measures include rate of script related words and measures of grammatical productivity. Results and computational models of acquisition, maintenance and generalization will contribute new evidence to support not just the efficacy and delivery of Aphasia Scripts, but also the application of practice principles to aphasia treatment in general.