Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) in Persons with Apraxia of Speech

中风后言语失用症（AOS）的治疗需要频繁和持续的言语练习- 语言病理学家促进持久的行为改变，这是昂贵的，因此，许多人无法获得 患者因此，迫切需要确定新的、具有成本效益的方法来补充言语治疗， 增加实践机会并优化治疗结果。我们的长期目标是发展一个 有效的、家庭练习的、基于计算机的运动想象方案 和疗效（MI-TEE）]，将作为常规语言治疗的辅助手段，以优化治疗反应 在患有AOS的人中。本申请的总体目标是（i）评估可接受性和可行性 MI-TEE作为家庭实践项目的有效性，以及（ii）确定MI-TEE与语言治疗的有效性，比较 单独的言语治疗，在改善AOS患者的言语产生方面。我们的核心假设是，MI- 经食管超声心动图将是一种可获得的，可行的，有效的辅助语言治疗。为了实现我们的目标， 将使用两个具有多个基线的单一受试者实验设计来追求以下具体目标 受试者（n=18）：1）评价MI-TEE作为语言治疗辅助手段的可接受性和可行性 AOS的康复;和2）比较连续性MI-TEE加标准语音治疗与 标准的语言治疗在第一个目标下，观察数据、调查和半结构化访谈 将用于评估可接受性（感知满意度、适当性和继续使用的意图） 和可行性（招募、保留和干预依从率）。对于第二个目标， 将在治疗前测量训练单词和未训练单词的发音准确度（泛化）， 在治疗期间和治疗后重复。语音准确性的提高将是 使用二进制评分系统记录（正确/不正确）。将使用多水平分析来解决比率问题 获取，整体变化和参与者之间的反应差异。该研究具有创新性 因为它的重点是建立一个工具，增加独立的实践目标刺激的人， AOS以一种方便和廉价的方式。到目前为止，AOS循证治疗的结果 在受控实验室或临床环境中进行检查。现在有强有力的证据支持 这些治疗的好处，必须优化结果，并提供更经济，更容易获得 实践机会。拟议的研究是重要的，因为它预计将作为基础， 一项更大规模的临床试验（R 01），实施MI-TEE以提高AOS患者的治疗反应。具体地说， 这条研究路线将产生一个可访问的和有效的工具，将提供更多的机会， 实践，以提高治疗反应，并降低与频繁的面对面语言治疗相关的成本。 这一系列研究的预期成果涉及NIDCD的优先领域：（领域3）改善 治疗人类交流障碍和（领域4）改善人类交流的结果。

Treatment of post-stroke apraxia of speech (AOS) requires frequent and ongoing practice with a speech- language pathologist to facilitate lasting behavioral change, which is costly and, therefore, inaccessible to many patients. Thus, there is a critical need to identify novel, cost-effective ways to supplement speech therapy to increase opportunities for practice and optimize treatment outcomes. Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol [Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE)] which will serve as an adjunct to routine speech therapy to optimize treatment response in persons with AOS. The overall objectives of this application are to (i) evaluate the acceptability and feasibility of MI-TEE as a home practice program and (ii) determine the efficacy of MI-TEE with speech therapy, compared to speech therapy alone, in improving speech production in people with AOS. Our central hypothesis is that MI- TEE will be an accessible, feasible, and efficacious adjunct to speech therapy. To attain our objectives, the following specific aims will be pursued using two single-subject experimental designs with multiple baselines across participants (n=18): 1) Evaluate the acceptability and feasibility of MI-TEE as an adjunct to speech therapy for the rehabilitation of AOS; and 2) Compare the efficacy of adjunctive MI-TEE plus standard speech therapy to standard speech therapy alone. Under the first aim, observational data, surveys, and semi-structured interviews will be employed to assess the acceptability (perceived satisfaction, appropriateness, and intent to continue use) and feasibility (recruitment, retention, and intervention adherence rates) of MI-TEE. For the second aim, accuracy of articulation for trained words and untrained words (generalization) will be measured pre-treatment, repeatedly during the treatment phase, and post-treatment. Improvements in speech accuracy will be documented using a binary scoring system (correct/incorrect). Multilevel analyses will be used to address rate of acquisition, overall change, and response variation across participants. The proposed research is innovative because it focuses on establishing a tool for increasing independent practice of target stimuli for people with AOS in an accessible and inexpensive manner. Until now, outcomes for evidence-based treatments for AOS have been examined in controlled laboratory or clinical settings. Now that strong evidence exists to support the benefit of these treatments, it is imperative to optimize outcomes and provide more economical and accessible practice opportunities. The proposed research is significant because it is expected to serve as the foundation for a larger clinical trial (R01) implementing MI-TEE to advance treatment response in people with AOS. Specifically, this line of research will yield an accessible and efficacious tool that will provide additional opportunities for practice to enhance treatment response and reduce costs associated with frequent in-person speech therapy. The anticipated outcomes from this line of research address NIDCD’s Priority Areas: (Area 3) to improve treatment of disorders of human communication and (Area 4) to improve outcomes for human communication.