Efficacy and Optimization of Speech Entrainment Practice for People with Aphasia

失语症患者言语诱导练习的效果和优化

• 批准号: 10666552
• 负责人: Marja-Liisa Mailend
• 金额: $ 16.3万
• 依托单位: ALBERT EINSTEIN HEALTHCARE NETWORK
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10666552
• 关键词: Acquired Communication Disorders; Activities of Daily Living; Address; Adopted; Affect; Aftercare; American; Aphasia; Attention; Auditory; Behavioral; Brain; Case Series; Characteristics; Chronic; Clinical; Clinical Trials; Cognitive; Communication; Communities; Comprehension; Cues; Data Set; Family member; Foundations; Goals; Grant; Guidelines; Hearing; Human; Individual; Investigation; Language; Language Development; Language Disorders; Learning; Left; Lesion; Linguistics; Methods; Modality; Modeling; Movement; Neuroanatomy; Oral cavity; Outcome; Output; Participant; Patients; Performance; Persons; Production; Quality of life; Randomized; Research; Research Design; Role; Schedule; Speech; Stroke; Techniques; Testing; Time; Training; Treatment outcome; Visual; aphasia recovery; aphasia rehabilitation; design; effective therapy; efficacy study; experience; improved; indexing; individualized medicine; interest; language impairment; neural; programs; remediation; response; secondary outcome; trait; treatment effect; treatment response

PROJECT SUMMARY Among the 795 000 Americans who have a stroke each year, about 84 000 experience chronic aphasia—an impairment of language production, and often to a lesser extent, comprehension, that can severely impact the quality of life for people living with aphasia and their family members. Research has shown that people with chronic aphasia can benefit from treatment, but significant communication challenges often persist beyond conclusion of therapy. This project aims to test and develop a promising treatment technique, termed speech entrainment, to enhance treatment outcomes for people with aphasia. Speech entrainment refers to speaking in unison with a model speaker by imitating the model in real time. Research has shown that speech entrainment is a ground-breaking technique for prompting connected speech in people with aphasia. Even those whose independent speech is limited to a few single words may be able to increase their speech output many-fold in a speech entrainment context. This immediate stimulation effect is well-documented. What remains poorly understood is whether practicing speech production along with an entrainment model will enhance independent speech at a later point in time when the entrainment support is removed. In addition, conditions that optimize outcomes and characteristics of those who benefit have not been investigated beyond the immediate stimulation. Thus, this project aims to (1) experimentally establish the direct effect of speech entrainment practice on independent speech production post-treatment, (2) identify conditions that enhance treatment benefits, and (3) define the cognitive-linguistic and neuroanatomic profiles that are associated with a positive treatment response. These aims are addressed in a within-subject efficacy study, where 40 people with aphasia produce different stories with entrainment support. Speaking without entrainment is evaluated one day before and one day after speech entrainment practice. Different practice stories will be randomized within participants to three experimental conditions to assess the effect of treatment (trained vs. untrained), training schedule (massed vs. distributed presentation of stories), and entrainment modality (practice with auditory-only or audiovisual model). Correct information units per minute for each story will be tallied to evaluate the differences between conditions and the associations with patient characteristics. For consistency with prior research, number of different words per minute will serve as a secondary outcome. The proposed research addresses a clinical need by testing and optimizing a promising treatment technique for enhancing aphasia rehabilitation. In addition, this study serves as pilot research for a subsequent R01 grant. Guided by the findings from this study, the subsequent clinical trial establishes the efficacy of speech entrainment practice in a full-scaled treatment study, implemented at intensities that are designed to test long-term benefits.

项目总结 在每年罹患中风的795000美国人中，约有84000人患有慢性中风。 失语症--一种语言产出的障碍，通常在较小程度上是理解障碍，这可能 严重影响失语症患者及其家人的生活质量。研究表明， 慢性失语症患者可以从治疗中受益，但严重的沟通困难往往 坚持到治疗结束之后。该项目旨在测试和开发一种有前景的治疗技术， 称为言语夹带，以提高失语症患者的治疗结果。言语夹带 指的是通过实时模仿模型来与模型演讲者一致发言。研究表明， 语言夹带是一种突破性的技术，可以在失语症患者中促进连通语言。 即使那些独立发言被限制在几个单独的单词的人，也可能能够增加他们的演讲 在演讲夹带上下文中输出多倍。这种立竿见影的刺激效果是有据可查的。什么 人们仍然不太清楚的是，练习言语产生和夹带模式是否会 在稍后移除夹带支撑物时增强独立发言能力。此外, 那些优化结果和受益者特征的条件还没有被调查过 即刻的刺激。因此，本项目的目标是：(1)通过实验建立言语的直接效应 对独立言语产生后处理的夹带实践，(2)确定增强 治疗益处，以及(3)定义与治疗相关的认知语言和神经解剖学概况 治疗反应为阳性。这些目标在一项受试者内部的功效研究中得到了解决，其中40人 失语症患者在夹带的支持下产生不同的故事。说没有夹带的话是一种评价 演讲夹带练习的前一天和后一天。不同的实践案例将在 受试者在三种实验条件下评估治疗效果(训练与未训练)、训练 时间表(故事的集中呈现与分散呈现)和夹带通道(仅在听觉上练习 或视听模型)。将对每个故事每分钟的正确信息单位进行统计，以评估 病情之间的差异以及与患者特征的关联。与先前版本保持一致 研究表明，每分钟不同的词数将是次要的结果。拟议的研究 通过测试和优化一种前景看好的增强失语症的治疗技术来满足临床需求 康复。此外，这项研究作为后续R01赠款的试点研究。在指导下 这项研究的发现，随后的临床试验确立了言语夹带练习在 一项全面的治疗研究，实施的强度旨在测试长期益处。