Tonic and Phasic Alertness Training For the Treatment of Hemineglect

描述(由申请人提供)：当前项目的目标是开发和测试计算机化注意力训练程序(TAPAT-ATT)，以满足中风或创伤性脑损伤后半空间忽视患者的需求。作为一个整体，这些患者的长期预后往往较差，并且比其他具有类似大小病变的患者组更有可能需要管理性护理。我们最近的研究表明，专注于持续注意力和警觉的短暂、主动性和阶段性注意力训练(TAPAT)可以产生持续的益处，在没有额外训练的情况下可以持续数周。目前工作的总体目标是减少我们在实验室制定的培训战略，通过优化刺激提供参数和详细制定培训，以期扩大赤字改善的范围，延长和加强持久复苏。具体地说，我们将1)通过迭代计划优化(Agile Scrum)开发过程确定最佳刺激传递形式和参数，以最大化治疗培训收益，并使用迭代计划优化(Agile Scrum)开发过程确定最佳培训组合形式和最佳刺激集和任务参数，该过程将依赖于从个别计划用户测量的结果，以及由个别受训者和焦点小组记录的对培训计划用户界面设计的反馈。我们还将，2)根据替代培训计划来衡量培训结果，以进一步确定如何实施和控制培训计划，以确保强劲和持久的恢复。高度结构化的渐进式注意力技能培训模块使我们能够快速评估患者的表现，将用于评估这些新形式的Tapat培训的效果。这一正在进行的评估策略将使我们能够量化在被忽视的领域内外在注意力和工作记忆的几个关键领域取得的学习速度和渐近表现。此外，我们的初步证据表明，这种综合训练方法(TAPAT之后是注意力技能训练模块)可能会产生协同效应，提高TAPAT和更高级别技能训练的有效性。为了评估这一效果，在基线和完成培训后，我们将衡量培训任务中的改进对未经培训的注意力和工作记忆的标准化测量的概括性。我们还将继续利用敏感的注意力和知觉心理物理测量来评估培训结果。在这个项目完成时，我们将拥有足够的结果数据来支持一个更大的随机对照研究，以及足够的训练数据来构建将在第二阶段研究中评估的最终形式的“医疗”产品模型。 公共卫生相关性：该项目的目标是开发和测试一种新的、计算机化的治疗半侧空间忽视患者的方法，为一项广泛的第二阶段研究做准备。这一点很重要，因为与病变大小相当的相似患者组相比，这一庞大的患者群体预后较差，而且明显缺乏可行的治疗选择。

DESCRIPTION (provided by applicant): The goal of the current project is to develop and test a computerized attention training program (TAPAT-ATT) to meet the needs of patients with hemispatial neglect following stroke or traumatic brain injury. As a group, these patients tend to have poorer long-term prognosis and are more likely to require managed care than other patient groups with lesions of comparable size. Our recent studies are among the first to demonstrate that brief, tonic and phasic attention training (TAPAT) focused on sustained attention & vigilance can produce lasting benefits that persist for weeks in the absence of additional training. The overall goal of the current work is to reduce the training strategies that we have developed in the lab to practice by optimizing stimulus-delivery parameters and elaborating training in ways expected to increase the range of deficits ameliorated and to prolong and strengthen enduring recovery. Specifically, we will 1) determine the optimal stimulus delivery formats and parameters for maximizing therapeutic training benefits and determine the optimum combinative forms of training and the optimum stimulus sets and task parameters using an iterative program optimization (Agile SCRUM) development process which will rely on outcomes measured from individual program users, and on feedback on user interface designs of training programs recorded by individual trainees and from focus groups. We will also, 2) measure training outcomes as a function of alternative training schedules to further define how to implement and control training schedules that can assure strong and long-lasting recovery. Highly structured progressive attention-skills training modules that allow us to rapidly assess patient performance will be used to evaluate the effects of these new forms of TAPAT training. This ongoing assessment strategy will allow us to quantify learning rates and asymptotic performances achieved within and outside of the neglected field, across several key domains of attention and working memory. Further, our preliminary evidence suggests that this combined training approach (TAPAT followed by attention-skills training modules) may provide synergistic effects, enhancing the effectiveness of both TAPAT and higher-order skills trained. To evaluate this effect, at baseline and after the completion of training, we will measure the generalization of improvements in the training task to untrained standardized measures of attention and working memory. We will also continue to utilize sensitive psychophysical measures of attention and perception to evaluate training outcomes. At the completion of this project we will have outcomes data sufficient for powering a larger randomized controlled study, and training data sufficient for constructing the final form of the 'medical' product model that will be evaluated in the Phase II study. PUBLIC HEALTH RELEVANCE: The goal of this project is to develop and test a novel, computerized treatment for patients with hemispatial neglect in preparation for a widespread Phase II study. This is important because this large patient population suffers from poor prognosis relative to similar patient groups with lesions of comparable size and there is a conspicuous lack of viable treatment options.