Transferring Speed of Processing Gains to Everyday Cognitive Tasks after Stroke

将中风后处理速度的提高转移到日常认知任务中

• 批准号: 10684205
• 负责人: KARLENE K BALL
• 金额: $ 59.83万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-05 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10684205
• 关键词: Address; Adult; Affect; Aftercare; Automobile Driving; Basic Science; Behavioral; Caregivers; Caring; Cognition; Cognitive; Cognitive deficits; Communities; Data; Dementia; Disease; Elderly; Evaluation; Exhibits; Family member; Impaired cognition; Impairment; Individual; Intervention; Laboratories; Life; Measurement; Measures; Methods; Modeling; Motor; Movement; Outcome; Participant; Patient Care; Patients; Performance; Persons; Prevalence; Procedures; Process; Quality of life; Randomized, Controlled Trials; Rehabilitation therapy; Research; Research Personnel; Research Proposals; Sample Size; Sampling; Savings; Signal Transduction; Site; Speed; Stroke; Task Performances; Techniques; Testing; Training; Work; arm; blood oxygenation level dependent response; care costs; caregiving; chronic stroke; cognitive ability; cognitive function; cognitive rehabilitation; cognitive task; cost; design; experience; follow-up; functional improvement; improved; information processing; instrumental activity of daily living; new combination therapies; novel; post stroke; post stroke cognitive impairment; processing speed; stroke patient; therapy design; treatment effect

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.

摘要 许多认知障碍患者的日常功能下降， 侵入性痴呆认知能力下降每延迟一年， 护理成本和不可估量的节省，为病人和家庭成员的生活质量。之时尚 慢性中风中的认知障碍约为50%。已经发现许多技术 提高对训练情境的各方面认知。然而，他们的日常生活 在培训环境之外的学习和保留都受到限制。因此，它们具有减少或缩小的实用性。 值一种认知能力得到了改善，但没有用来提高现实世界的表现， 意义试点工作已经在这里进行，旨在填补这些关键空白的新的干预措施。 结果非常有希望。这项研究的目的是进行一项随机对照研究， 随机对照试验（RCT）的样本量足够大，以严格评估这些初步结果。 即将测试的新疗法结合了两种反复验证的康复方法： CI运动疗法与认知加工速度训练组合。这样做的目的是 在将认知改善从培训环境转移到 工具性日常生活活动（IADL）。新的联合疗法的两部分 都是建立在研究者自己的基础研究之上的在这两种情况下，疗效都得到了积极结果的支持 来自多个单中心RCT和一个大型多中心RCT。然而，处理速度训练的效果 已经发现，在日常情况下，对基于认知的IADL的推广有限。相比之下， CI疗法的主要优势之一是，它产生了强大而广泛的治疗效果转移， 日常生活中的情况，部分手段，其转让包。转移包的第二个优势 CI治疗的关键是长期保持其疗效。在我们最初的工作中， 实验室已经有效地用于将运动增益从治疗转移到日常设置， 从治疗到日常环境的认知增益。 我们在这里提出了一个RCT，有两个分支：实验室中的处理速度训练（SOPT）， 在实验室中测定TP（TP+）和SOPT，但不测定TP（TP-）。参与者将是120名1岁以上的成年人 中风后伴有轻度至中度认知障碍。认知任务的表现将是 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测量 事后这种设计将允许对转移包的价值进行严格的测试， 样本量、客观测量、设盲和受试者间对照的数量和强度 培训和治疗师联系。