A comparison of the effects of dosage and group dynamics on discourse outcomes in aphasia

剂量和群体动态对失语症话语结果影响的比较

• 批准号: 9231559
• 负责人: Elizabeth L Hoover
• 金额: $ 17.68万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9231559
• 关键词: Acute; Address; Affect; Aftercare; American; Aphasia; Aphasia Tests; Books; Chronic; Client; Communication; Communication impairment; Conflict (Psychology); Control Groups; Controlled Study; Cues; Disadvantaged; Enrollment; Family; Foundations; Friends; Gestures; Goals; Group Processes; Health; Impairment; Individual; Knowledge; Language; Learning; Linguistics; Maintenance; Medical; Modeling; Nature; Outcome; Outcome Measure; Participant; Patient Outcomes Assessments; Peer Group; Performance; Psychotherapy; Randomized; Recommendation; Reporting; Research; Resources; Role; Services; Severities; Site; Social Network; Social isolation; Socialization; Speech; Speech Pathologist; Standardization; Stroke; Testing; Time; Treatment Effectiveness; Treatment outcome; United States; base; cost; dosage; evidence base; experience; health care delivery; improved; innovation; member; mortality; multimodality; primary outcome; programs; public health relevance; secondary outcome; skills; teacher; theories; treatment effect; treatment group

Project Summary The communication impairments associated with aphasia limit participation in vocational and other activities, such as socializing with family or friends and medical decisions. The resulting social isolation is often a long-term issue due to the chronic nature of aphasia and limited access to speech language services. The goal of this research is to answer a relatively basic question about how to format treatment for people with aphasia: How many people should be in treatment sessions? Group treatment has the potential to improve communication and reduce social isolation, while also reducing medical costs. However, this treatment format lacks a strong evidence base. This project seeks to address this problem by investigating how two conflicting hypotheses – treatment dosage and group dynamics – affect conversational treatment outcomes. Treatment dosage refers to the idea that treatment benefits are enhanced when clients have a greater number of practice trials during treatment. This hypothesis predicts that clients will show greater treatment effects when treatment sessions involve a small number of clients, because clients have many opportunities to practice target skills. Group dynamics refers to the hypothesis that working with a group of peers who have similar impairments leads to better treatment outcomes than working with smaller groups of clients, due to variables such as interpersonal learning. The proposed study will compare these hypotheses in the context of a well-motivated and operationalized conversational treatment. Across two sites, we will enroll 48 participants with chronic aphasia due to a stroke in the language-dominant hemisphere. All participants will be randomly assigned to one of three conditions: dyad treatment (2 clients per session), traditional group treatment (8 clients per session) or delayed control group. Treatment will occur for 60 minutes, twice a week for 10 weeks. During treatment sessions, a speech pathologist will facilitate discourse using linguistic and multimodal cueing hierarchies, which will be tailored to individual client goals. The primary outcome measure will evaluate how efficiently individuals with aphasia communicate information during a picture description task. Additional outcome measures will include standardized tests and patient reported outcome measures, which evaluate both changes in real-world communication ability and in social isolation. We will examine treatment effects associated with dyads and traditional groups immediately after treatment and one year after treatment, in order to determine whether treatment effects persist over time. This is a significant contribution because it will advance knowledge regarding how to optimize treatment for individuals with chronic aphasia. This study also provides the foundation for a research program that will systematically examine conversational treatment, including how differences in the treatment and individual (e.g., aphasia severity) influence treatment outcomes.

项目概要 与失语症相关的沟通障碍限制了职业和其他活动的参与 活动，例如与家人或朋友的社交以及医疗决策。由此产生的社会孤立往往是 由于失语症的慢性性质和获得言语服务的机会有限，这是一个长期问题。这 这项研究的目标是回答一个相对基本的问题，即如何为患有此病的人制定治疗方案 失语症：应该有多少人参加治疗？团体治疗有改善的潜力 沟通并减少社会隔离，同时还降低医疗费用。然而，这种治疗形式 缺乏强有力的证据基础。该项目旨在通过调查两个相互冲突的问题如何解决这个问题 假设——治疗剂量和群体动态——影响对话治疗结果。治疗 剂量是指当客户进行更多练习时，治疗效果会增强 治疗期间的试验。该假设预测客户在接受治疗时将表现出更好的治疗效果 课程只涉及少数客户，因为客户有很多机会练习目标技能。 群体动力是指与一群有类似障碍的同龄人一起工作的假设 由于以下变量，与较小的客户群体合作相比，可以带来更好的治疗结果 人际学习。拟议的研究将在有充分动机的背景下比较这些假设 和可操作的对话治疗。我们将在两个地点招募 48 名患有慢性病的参与者 由于语言优势半球中风而导致的失语症。所有参与者将被随机分配到 三种情况之一：双人治疗（每次 2 名客户）、传统团体治疗（每次 8 名客户） 会话）或延迟对照组。治疗时间为 60 分钟，每周两次，持续 10 周。期间 治疗过程中，言语病理学家将使用语言和多模式提示促进话语 层次结构，将根据个人客户的目标进行定制。主要结果指标将评估如何 失语症患者在图片描述任务中有效地交流信息。额外的 结果测量将包括标准化测试和患者报告的结果测量，其评估 现实世界沟通能力和社会孤立的变化。我们将检查治疗效果 治疗后立即和治疗后一年与二元组和传统组相关，以便 以确定治疗效果是否随着时间的推移持续存在。这是一项重大贡献，因为它将 增进有关如何优化慢性失语症患者治疗的知识。这项研究还 为系统地检查对话处理的研究计划提供基础， 包括治疗和个体差异（例如失语症严重程度）如何影响治疗结果。