Modulating stimulus intensity to improve clinical outcomes in aphasia treatment

调节刺激强度以改善失语症治疗的临床结果

• 批准号: 10642964
• 负责人: Leora R Cherney
• 金额: $ 60.27万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-09 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10642964
• 关键词: 3-Dimensional; Address; Affective; Aftercare; Aphasia; Behavior; Client; Clinical; Clinical Treatment; Cognitive Science; Communication impairment; Communities; Complex; Computer Models; Computers; Dose; Educational process of instructing; Effectiveness; Elements; Ensure; Environment; Frequencies; Goals; Home; In Situ; Individual; Intervention; Investigation; Larynx; Learning; Linguistics; Literature; Longevity; Maintenance; Measures; Modeling; Names; Neurologic; Neuronal Plasticity; Neurosciences; Outcome; Participant; Pattern; Personality; Persons; Privacy; Production; Reporting; Research; Response Generalization; Schedule; Secondary to; Speech Intelligibility; Stimulus; Stimulus Generalization; Tablets; Time; Training; Treatment Effectiveness; clinical application; clinical practice; computerized; cost; cost effective; cost effective treatment; design; improved; innovation; long-term rehabilitation; primary outcome; randomized, clinical trials; secondary outcome; sensor; sound; treatment arm; treatment program; virtual; visual speech; wireless

Abstract Determining the optimal intensity of treatment is essential to the design and implementation of any treatment program for aphasia. Yet, treatment intensity is a complex construct and information on the variables modulating it remain ambiguous and limited. Studies reported in the neuroscience and clinical literature support the need for intensive treatment to induce long-term neuroplastic changes while the cognitive psychology literature suggests that learning is best maintained with distributed schedules. A few studies have looked at dose parameters for single word naming tasks, but there is limited evidence regarding dose parameters for treatments that focus on training the production of larger units, such as sentences or even connected discourse. One approach that is frequently used clinically and has evidence for its efficacy is script training. Little is currently known regarding the optimum dose of script training (i.e., the number of repetitions over time of each sentence within the script) that is required to promote the best outcomes. In this proposal we conduct a two-factor RCT on the effects of modulating stimulus variables, specifically stimulus practice distribution and stimulus repetition. We use a baseline script treatment that has experimental support regarding its efficacy, and that allows the manipulation of these variables. To ensure independence and fidelity, treatment is provided in a controlled computer environment (desktop and tablet). To avoid clinician- related variables such as expertise and personality factors that may influence treatment, sentences are modeled during treatment by an anthropomorphic agent with high visual speech intelligibility and affective expressions. With regard to “best outcomes”, generalization is the ultimate goal of any treatment approach. Therefore, the primary outcome is a generalization measure of conversation. Secondary measures address short-term acquisition, longer-term maintenance, and response generalization for assessing gain over baseline, differential effects, and interactions. A mobile-connected wireless wearable laryngeal sensor allows tracking of talk time at home and in the community as a measure of treatment effectiveness and transfer. For privacy, it does not record audio. Results and computational models of learning (generalization, short-term acquisition, and longer-term maintenance) will contribute new evidence to fill critical gaps in current scientific understanding regarding the effectiveness and clinical application of aphasia treatment approaches. More generally, findings will help to inform clinical practice and treatment of neurologic communication disorders; the virtual clinician guided intervention that the proposal develops has the potential to reduce costly clinician-client time otherwise required for long-term rehabilitation. .

抽象的 确定最佳治疗强度对于任何治疗方案的设计和实施都至关重要 失语症的治疗方案。然而，治疗强度是一个复杂的结构和变量信息 对其进行调节仍然模糊且有限。神经科学和临床文献中报道的研究 支持强化治疗的需要，以诱导长期的神经塑性变化，同时认知 心理学文献表明，分布式时间表可以最好地维持学习。一些研究已经 研究了单词命名任务的剂量参数，但有关剂量的证据有限 专注于训练较大单位（例如句子甚至句子）的产生的治疗参数 连接的话语。临床上经常使用且有证据证明其有效性的一种方法是脚本 训练。目前对于脚本训练的最佳剂量（即重复次数）知之甚少 随着脚本中每个句子的时间的推移），这是促进最佳结果所必需的。 在本提案中，我们对调节刺激变量的影响进行了双因素随机对照试验，特别是 刺激练习分布和刺激重复。我们使用具有实验性的基线脚本处理 支持其功效，并且允许操纵这些变量。确保独立性 和保真度，治疗是在受控的计算机环境（台式机和平板电脑）中提供的。为了避免临床医生- 相关变量，例如可能影响治疗的专业知识和个性因素，句子是 在治疗期间由具有高视觉语言清晰度和情感的拟人化代理建模 表达式。 关于“最佳结果”，泛化是任何治疗方法的最终目标。所以， 主要结果是对话的概括性衡量。次要措施解决短期问题 获取、长期维护和响应概括，用于评估基线增益， 差异效应和相互作用。移动连接的无线可穿戴喉部传感器可以跟踪 在家中和社区中的谈话时间作为治疗效果和转移的衡量标准。为了隐私，它 不录制音频。 学习的结果和计算模型（泛化、短期习得和长期习得） 维护）将提供新的证据，以填补当前科学认识中的关键空白 失语症治疗方法的有效性和临床应用。更一般地说，研究结果将有助于 为神经沟通障碍的临床实践和治疗提供信息；虚拟临床医生指导 该提案制定的干预措施有可能减少昂贵的临床医生与客户的时间 需要长期康复。 。