Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia

定义失语症的语言、认知交际和生活质量结果的轨迹

• 批准号: 10614491
• 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: 2019-04-10 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614491
• 关键词: Admission activity; Adult; Affect; Agreement; Aphasia; Biological Markers; Brain; Brain-Derived Neurotrophic Factor; Caregivers; Caring; Characteristics; Clinical; Cognitive; Communication; Decision Making; Dose; Functional Magnetic Resonance Imaging; Genetic; Genetic Markers; Genetic Polymorphism; Goals; Growth; Health; Health Care Costs; Heterogeneity; Hospitals; Individual; Inpatients; Language; Language Therapy; Length of Stay; Lesion; Linguistics; Location; Longitudinal cohort study; Measurement; Measures; Methodology; Methods; Modeling; Monitor; Neurobiology; Neuronal Plasticity; Outcome; Outcome Measure; Outpatients; Participant; Pathology; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Persons; Predictive Factor; Prevalence; Productivity; Prospective Studies; Prospective cohort; Public Health; Quality of life; Recovery; Rehabilitation therapy; Rest; Sampling; Services; Severities; Speech Therapy; Standardization; Stroke; Survivors; System; Testing; Treatment Factor; Variant; Work; aphasia recovery; clinical practice; cohort; cost; design; functional gain; health related quality of life; improved; improved outcome; innovation; instrument; nervous system disorder; neuroimaging marker; patient oriented; post stroke; programs; prospective; recruit; rehabilitation service; response; service delivery; sound; stroke patient; stroke rehabilitation; stroke-induced aphasia

Stroke imposes significant burdens on the health and quality of life of survivors and their caregivers, and presents a major public health issue in terms of healthcare costs and lost productivity. Aphasia adds to the cost of stroke- related care. Many stroke survivors with aphasia receive therapy in inpatient rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of inpatient rehabilitation on outcomes. The objective of this study is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (QoL) outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilita- tion to 18 months following stroke. A sampleof 300 consecutively-admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological Disorders (Neuro-QoL) Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We will model outcomes as individual and group trajectories, allowing us to develop individual predictions which could inform clinical planning and decision-mak- ing for new patients. The Specific Aims are to: Aim 1: Establish a prospective cohort of stroke patients with aphasia, and define their typical trajectory of lin- guistic, cognitive-communicative, and health-related QoL recovery at admission to and discharge from the IRF, and at 6, 12, and 18 months post onset. Aim 2: Identify factors that are associated with linguistic, cognitive-communicative, and health-related QoL out- comes from among the following: patient factors including demographic and clinical characteristics related to stroke and aphasia; treatment variables including inpatient and outpatient aphasia therapy characteristics and informal aphasia services; and biomarkers, including genetic and neuroimaging biomarkers. Aim 3: Evaluate the stability of the models of linguistic, cognitive-communicative, and health-related QoL out- comes recovery that are developed from Aims 1 and 2. This study is innovative in its use of (1) standardized assessments that measure not only linguistic outcomes but also communication and QoL outcomes; (2) patient-centered, self-report instruments such as Neuro-QoL to de- tect clinically important change through 18 months post-stroke; (3) individual growth curve analysis to describe recovery trajectories and examine associations between demographic, lesion, aphasia, genetic, and speech and language therapy characteristics; (4) biomarkers that have been implicated in promoting neuroplasticity; (5) rest- ing state functional magnetic resonance imaging to evaluate the association between network pathology and recovery from aphasia; (6) information on type, amount, and duration of aphasia treatment provided in clinical settings; and (7) information on informal aphasia services following discharge from formal therapy.

中风对幸存者及其照顾者的健康和生活质量造成重大负担， 就医疗成本和生产力损失而言，这是一个重大的公共卫生问题。失语症增加了中风的成本- 相关护理。许多患有失语症的中风幸存者在住院康复机构接受治疗。然而， 失语症的恢复是可变的，关于住院康复对预后的益处的证据有限。 这项研究的目的是描述语言、认知-交际和健康相关的运动轨迹 失语症患者在住院和门诊康复期间卒中后的生活质量结果 至中风后18个月。300例连续入院的卒中失语患者样本研究 在中西部的三家康复医院将完成语言和认知-交际的测量 神经疾病(Neuro-QOL)测量系统仪器的性能和生活质量 在康复期间以及中风后6个月、12个月和18个月。我们将以个人和团队的方式来模拟结果 轨迹，允许我们开发个人预测，这些预测可以为临床规划和决策提供信息- 为新病人服务。具体目标是： 目的1：建立卒中失语症患者的前瞻性队列，确定其典型的LIN-LINE轨迹。 在IRF入院和出院时，进行Guistic、认知-沟通和健康相关的QOL恢复， 以及发病后6、12和18个月。 目标2：确定与语言、认知-交际和健康相关的生活质量相关的因素-- 来自以下方面：患者因素包括与人口统计和临床特征相关的 中风和失语症；治疗变量包括住院和门诊失语症的治疗特点和 非正式失语症服务；生物标记物，包括遗传和神经成像生物标记物。 目的3：评价语言、认知-交际和健康相关生活质量模型的稳定性。 从目标1和目标2发展而来的复苏。 这项研究的创新之处在于它使用了(1)标准化评估，不仅衡量语言结果，而且还 沟通和生活质量结果；(2)以患者为中心的自我报告工具，如神经生活质量评估工具 检测卒中后18个月的临床重要变化；(3)个体生长曲线分析 恢复轨迹，并检查人口统计、病变、失语症、遗传和言语与 语言治疗的特点；(4)与促进神经可塑性有关的生物标志物；(5)休息- ING状态功能磁共振成像评估网络病理和 失语症的康复；(6)临床上提供的失语症治疗的类型、数量和持续时间的信息 (7)关于正式治疗出院后的非正式失语服务的信息。