Transferring Speed of Processing Gains to Everyday Cognitive Tasks after Stroke

摘要 许多有认知障碍的人在日常生活中可以发出信号的功能减少 侵袭性痴呆症。认知能力下降每推迟一年，患者就会节省大量资金 护理成本和患者及其家属在生活质量方面的不可估量的节省。疾病的流行 慢性卒中患者的认知功能障碍约占50%。已经发现了许多技术来 在训练情境中提高各方面的认知。然而，他们转移到了日常生活中 在培训环境之外的培训受到了限制，留用也是如此。因此，它们具有简化或狭义的实用性。 价值。认知能力得到了改善，但没有用来提高现实世界的表现，这是有限的 意义。已经在这里开展了试点工作，采取了一种旨在填补这些关键空白的新颖干预措施。 结果是非常有希望的。本研究的目的是进行随机对照研究。 以足够大的样本严格评估这些初步结果的试验(RCT)。 将接受测试的新疗法结合了两种反复验证的康复方法： CI运动疗法成套训练与认知加工速度训练。这样做的目的是 在将认知改善从培训环境转移到 日常生活的工具性活动(IADL)。新联合疗法的两个部分 是建立在调查人员自己的基础研究基础上的。在这两种情况下，疗效都得到了积极结果的支持。 来自多个单站点RCT和一个大型多站点RCT。然而，加工速度对训练的影响 已经发现，在日常情况下，对基于认知的IADL的概括有限。相比之下，只有一个 CI疗法的主要优点之一是它产生了强有力的和广泛的治疗效果转移到 日常生活的情况，部分是通过它的转移套餐来实现的。转会套餐的第二个优势 脑梗塞治疗的关键在于其疗效的长期保留。在我们最初的工作中，转会包程序是这样的 实验室已经有效地使用了将运动增益从治疗转移到日常环境中适应转移 从日常环境中的治疗中获得认知收益。 我们在这里提出了一个有两个手臂的RCT：结合实验室中的处理速度训练(SOPT)和 实验室中的TP(TP+)和SOPT，但没有TP(TP-)。参与者将是120名1岁以上的成年人 卒中后伴有轻度至中度认知障碍。基于认知的任务的绩效将是 在基线前后、治疗后以及6个月和12个月时在日常生活和实验室中进行测量 之后。这种设计将允许严格测试传输包的价值，并具有足够的 样本大小、客观测量、盲法和受试者之间的数量和强度控制 培训和治疗师联系。

ABSTRACT Many individuals with cognitive impairment experience decrements in everyday function that can signal encroaching dementia. For every year that cognitive decline is delayed there is substantial savings in patient care costs and inestimable savings in quality of life for patients and family members. The prevalence of cognitive impairment in chronic stroke is approximately 50%. A number of techniques have been found to improve various aspects of cognition in the training situation. However, their transfer to everyday situations outside the training setting has been limited as is retention. They are therefore of reduced or narrow practical value. A cognitive ability that is improved but not used to enhance real-world performance has limited significance. Pilot work has been carried out here with a novel intervention designed to fill these crucial gaps. The results are very promising. The purpose of the proposed research is to carry out a randomized controlled trial (RCT) with a large enough sample to rigorously evaluate these preliminary results. The new treatment to be tested combines two repeatedly validated rehabilitation methods: the Transfer Package of CI Movement Therapy and Speed of Cognitive Processing Training. The purpose of doing so is to produce a marked enhancement in the transfer of cognitive improvement from the training setting to instrumental activities of daily living (IADL) in everyday situations. Both halves of the new combination therapy are founded on the investigators' own basic research. In both cases, efficacy is supported by positive results from multiple single-site RCTs and a large multisite RCT. However, the effect of Speed of Processing Training has been found to have limited generalization to cognitive-based IADL in everyday situations. In contrast, one of the main strengths of CI Therapy is that it produces a robust and extensive transfer of treatment effect to everyday life situations by means, in part, of its Transfer Package. A second strength of the Transfer Package of CI Therapy is long-term retention of its effect. In our initial work, the Transfer Package procedures that this lab has used effectively to transfer motor gains from the treatment to everyday setting were adapted to transfer cognitive gains from the treatment to the everyday setting. We propose here an RCT with 2 arms: Speed of Processing Training (SOPT) in the lab combined with the TP (TP+) and SOPT in the lab but without the TP (TP-). Participants will be 120 adults more than 1-year post-stroke with mild to moderate cognitive impairment. Performance on cognitive-based tasks will be measured in daily life and in the lab before and after baseline, after treatment, and 6- and 12-months afterwards. This design will permit rigorous testing of the value of the Transfer Package with an adequate sample size, objective measurement, blinding, and between-subjects control for amount and intensity of training and therapist contact.