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侧空间忽视患者的需求。作为一个群体，这些患者往往有较差的长期预后，更有可能需要管理的护理比其他患者群体的病变相当的大小。我们最近的研究是第一批证明，专注于持续注意力和警惕性的短暂，紧张和阶段性注意力训练（TAPAT）可以产生持久的好处，在没有额外训练的情况下持续数周。目前工作的总体目标是减少我们在实验室中开发的训练策略，通过优化刺激传递参数和以预期增加改善的缺陷范围并延长和加强持久恢复的方式进行训练。具体而言，我们将1）确定最佳刺激递送格式和参数以使治疗训练益处最大化，并使用迭代程序优化来确定训练的最佳组合形式和最佳刺激集和任务参数（敏捷SCRUM）开发过程，将依赖于从单个程序用户处测量的结果，以及由个别受训人员和焦点小组记录的对培训方案用户界面设计的反馈。我们还将，2）测量培训结果作为替代培训计划的函数，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训练模块，使我们能够快速评估患者的表现将被用来评估这些新形式的TAPAT训练的效果。这种持续的评估策略将使我们能够量化被忽视领域内外的学习率和渐近表现，跨越注意力和工作记忆的几个关键领域。此外，我们的初步证据表明，这种组合的训练方法（TAPAT其次是注意力技能训练模块）可能会提供协同效应，提高TAPAT和高阶技能训练的有效性。为了评估这种效果，在基线和训练完成后，我们将测量训练任务中的改善对未训练的注意力和工作记忆标准化测量的泛化。我们还将继续利用敏感的注意力和感知的心理物理措施来评估培训成果。在该项目完成时，我们将获得足以支持更大规模随机对照研究的结局数据，以及足以构建将在II期研究中评价的“医疗”产品模型最终形式的训练数据。

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.