Aphasia Rehabilitation: Modulating Cues, Feedback & Practice

描述(由申请人提供)：很少有研究系统地调查失语症治疗过程中固有的理论驱动变量的影响，而不考虑具体的治疗方法。此外，最近强调需要强化失语症治疗，以便进行与中风后恢复和康复相关的长期神经可塑性改变，这导致了一种观念，即治疗越多越好。然而，关于有效实践分配和调度的具体信息是有限的。这项建议的目的是进行一系列干预研究，以考察不同的治疗变量和练习条件如何影响慢性失语症康复中一项技能的短期获得和长期维持和推广。要做到这一点，最好的方法是使用单一的治疗范例，该范例有关于其有效性的实验支持，它适应了对变量的处理，如提示和反馈，并且具有容易观察和测量的结果。选定的治疗方法--失语症脚本--由拟人化的准确的“数字”治疗师在高度可控的计算机环境(网络、PC、平板电脑)中提供，能够对言语进行可视化建模并以交互方式指导治疗，从而通过消除可能影响治疗结果的临床医生专业知识和个性因素等与临床医生相关的变量来确保治疗的独立性和保真度。首先，将进行交叉研究，以衡量线索对剧本训练的习得、维持和概括的影响。参与者将被随机分为减少错误的条件或错误的条件。其次，为了测量外显自我监控训练和任务复杂性对脚本训练的习得、维持和概括的影响，受试者被随机分配到四种条件中的一种，这些条件因反馈(无反馈与自我反馈)和脚本复杂性(高复杂性与低复杂性)而不同。初步调查结果将用于修改现有的失语症脚本计划。第三，将使用修改后的失语症脚本程序评估练习分布和时间表对获得、维护和推广脚本训练的影响。受试者将被随机分配到四种情况中的一种，这些情况因练习时间表(封闭与随机)和练习分布(集中与分布)而有所不同。主要结果指标是与文字相关的词的产生的百分比；次要结果指标包括与文字相关的词的比率和语法生产率的指标。习得、维持和泛化的结果和计算模型将提供新的证据，不仅支持失语症脚本的有效性和交付，而且还支持实践原则在失语症治疗中的应用。

DESCRIPTION (provided by applicant): Few studies have systematically investigated the effects of theory-driven variables that are inherent to the aphasia treatment process, regardless of the specific treatment approach. Furthermore, recent emphasis on the need for intensive aphasia treatment in order to make the long-term neuroplastic changes associated with recovery and rehabilitation following a stroke has led to the notion that "more" treatment is better. Yet, specific information regarding effective practice distributions and scheduling is limited. The purpose of this proposal is to conduct a series of intervention studies to examine how different treatment variables and practice conditions affect short-term acquisition and long-term maintenance and generalization of a skill in the rehabilitation of chronic aphasia. This is best accomplished by using a single treatment paradigm that has experimental support regarding its efficacy, which accommodates the manipulation of variables such as cueing and feedback, and which has easily observable and measurable outcomes. The selected treatment, Aphasia Scripts, is delivered in a highly controlled computer environment (web, PC, tablet) by an anthropomorphically accurate "digital" therapist, capable of visually modeling speech and interactively guiding treatment, thereby ensuring treatment independence and fidelity by removing clinician-related variables such as clinician expertise and personality factors that potentially influence treatment outcomes. First, a cross-over study will be conducted to measure the effect of cues on acquisition, maintenance and generalization of script training. Participants will be randomized to an error-reducing condition or an errorful condition. Second, to measure the effect of explicit self-monitoring training and task complexity on acquisition, maintenance and generalization of script training, subjects will be randomly assigned to one of four conditions, that vary by feedback (no feedback versus self-feedback) and script complexity (high versus low complexity). Preliminary findings will be used to modify the existing Aphasia Scripts program. Third, the effect of practice distribution and schedules on acquisition, maintenance and generalization of script training will be assessed using the modified Aphasia Scripts program. Subjects will be randomly assigned to one of four conditions that vary by practice schedule (blocked versus random) and practice distribution (massed versus distributed). The primary outcome measure is the percent of script-related words produced; secondary outcome measures include rate of script related words and measures of grammatical productivity. Results and computational models of acquisition, maintenance and generalization will contribute new evidence to support not just the efficacy and delivery of Aphasia Scripts, but also the application of practice principles to aphasia treatment in general.