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: 9136710
• 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 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9136710
• 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; Production; Psycholinguistics; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Resources; Role; Sampling; Semantics; Services; Societies; Stimulus; Stimulus Generalization; Stroke; 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; education research; effectiveness research; follow-up; improved; lexical; phonology; point of care; post stroke; predictive marker; predictive of treatment response; prognostic; programs; psychosocial adjustment; relating to nervous system; response; standardize measure; stroke survivor; 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.

描述（由申请人提供）： 中风后语言和沟通障碍（失语症）影响超过 30% 的中风幸存者，每年新增病例超过 180,000 例。失语症的后果是深远的，会影响社会心理调整、家庭角色参与、职业机会以及在社会中独立运作的能力。 最近的估计表明，VHA 门诊每年新增 2000 例失语症病例，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，退伍军人事务部匹兹堡医疗系统老年研究、教育和临床中心 (GRECC) 于 2009 年 1 月启动了强化住宅失语症治疗和教育计划 (PIRATE)。PIRATE 是一个临床示范项目，在 4 周内为社区住宅退伍军人提供约 100 小时的认知语言导向失语症治疗。 PIRATE 目前每年为 18 名退伍军人提供双月一次的服务。一般来说，与海盗和失语症治疗相关的资源限制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）将从全国范围内参加 PIRATE 的退伍军人中招募。他们将在 PIRATE 进入之前、每周治疗期间以及项目退出/随访时测量他们的命名表现。在治疗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。参与者在经过训练和未经训练的词汇项目上的表现以及命名表现的标准化测量将在不同时间间隔进行比较，以指定实现最大治疗效果的治疗量。他们的治疗结果还将与特定的认知测试分数以及大脑病变的位置和范围相关联，以识别预测积极治疗反应的认知和神经标志物。还将对具有不同心理语言学特征的参与者的治疗反应进行比较，以确定哪些患者组从语义导向的命名治疗中表现出最大的益处。 拟议的研究应该回答两个相互关联的问题：失语症治疗对谁最有效，以及需要多少治疗才能优化治疗结果。这些答案有可能为 VHA 内如何提供失语症治疗设定变革性的新标准。