Aphasia Rehabilitation: Modulating Cues, Feedback & Practice

描述（由申请人提供）：很少有研究系统地研究失语治疗过程中固有的理论驱动变量的影响，而不管具体的治疗方法是什么。此外，最近强调需要强化失语症治疗，以使中风后恢复和康复相关的长期神经可塑性改变，这导致了“更多”治疗越好的概念。然而，关于有效练习分配和调度的具体信息是有限的。本研究旨在开展一系列干预研究，探讨不同的治疗变量和实践条件对慢性失语症康复中技能的短期习得、长期维持和推广的影响。这最好通过使用单一治疗范例来实现，该范例具有关于其有效性的实验支持，它适应诸如提示和反馈等变量的操作，并且具有易于观察和测量的结果。所选择的治疗，失语脚本，由拟人化准确的“数字”治疗师在高度控制的计算机环境（网络，PC，平板电脑）中提供，能够视觉建模语言并交互式指导治疗，从而通过消除临床医生相关的变量（如临床医生的专业知识和个性因素）来确保治疗的独立性和保真度。首先，本研究将进行交叉研究，以衡量线索对文字训练习得、维持和泛化的影响。参与者将被随机分配到减少错误的条件或错误的条件。其次，为了衡量外显自我监控训练和任务复杂性对脚本训练习得、维持和泛化的影响，受试者将被随机分配到四种条件中的一种，这些条件随反馈（无反馈与自我反馈）和脚本复杂性（高复杂性与低复杂性）的不同而变化。初步研究结果将用于修改现有的失语脚本项目。第三，使用改进的失语脚本程序评估练习分布和时间表对脚本培训的获取、维护和推广的影响。受试者将被随机分配到四种条件中的一种，这些条件根据练习计划（封闭还是随机）和练习分布（集中还是分布）而有所不同。主要的结果度量是生成的与脚本相关的单词的百分比；次要结果测量包括与文字相关的单词的比率和语法生产力的测量。获取、维持和推广的结果和计算模型将提供新的证据，不仅支持失语脚本的疗效和交付，而且支持实践原则在失语治疗中的应用。

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.