A comparison of the effects of dosage and group dynamics on discourse outcomes in aphasia

项目摘要 与失语症相关的沟通障碍限制了职业和其他方面的参与 活动，如与家人或朋友的社交和医疗决策。由此产生的社会孤立往往是 由于失语症的慢性性质和获得言语语言服务的机会有限，这是一个长期问题。这个 这项研究的目的是回答一个相对基本的问题，即如何为患有癌症的患者制定治疗方案 失语症：应该有多少人参加治疗？集体治疗有改善的潜力 沟通和减少社会隔离，同时也降低医疗成本。然而，这种治疗形式 缺乏强有力的证据基础。这个项目试图通过调查两个相互冲突的 假设-治疗剂量和群体动态-影响对话治疗结果。治疗 剂量指的是当患者进行更多的实践时，治疗收益会增加的想法 在治疗过程中进行试验。这一假说预测，患者在接受治疗时会表现出更大的治疗效果。 课程只涉及少量客户，因为客户有很多机会练习目标技能。 团队动力学指的是与一群有相似缺陷的同事一起工作的假设 与与较小的客户群体合作相比，由于以下变量，导致更好的治疗结果 人际学习。拟议的研究将在动机良好的背景下比较这些假设 和操作化的对话治疗。在两个站点，我们将招募48名患有慢性病的参与者 语言占主导地位的大脑半球中风导致的失语症。所有参与者将被随机分配到 三种情况之一：DYAD治疗(每期2名客户)、传统团体治疗(每期8名客户 会话)或延迟对照组。治疗时间为60分钟，每周两次，为期10周。在.期间 治疗过程中，语言病理学家将使用语言和多模式提示来促进话语 层次结构，将根据个人客户目标量身定做。主要结果衡量标准将评估如何 失语症患者在图片描述任务中有效地交流信息。其他内容 结果测量将包括标准化测试和患者报告结果测量，它们评估 无论是在现实世界的沟通能力方面，还是在社交孤立方面。我们将检查治疗效果 在治疗后即刻和治疗后一年内与二联体和传统组相关联，依次为 以确定治疗效果是否会随着时间的推移而持续。这是一个重大贡献，因为它将 关于如何优化慢性失语症患者治疗的高级知识。这项研究还 为系统检查会话治疗的研究计划提供了基础， 包括治疗和个体差异(例如，失语症的严重程度)如何影响治疗结果。

Project Summary The communication impairments associated with aphasia limit participation in vocational and other activities, such as socializing with family or friends and medical decisions. The resulting social isolation is often a long-term issue due to the chronic nature of aphasia and limited access to speech language services. The goal of this research is to answer a relatively basic question about how to format treatment for people with aphasia: How many people should be in treatment sessions? Group treatment has the potential to improve communication and reduce social isolation, while also reducing medical costs. However, this treatment format lacks a strong evidence base. This project seeks to address this problem by investigating how two conflicting hypotheses – treatment dosage and group dynamics – affect conversational treatment outcomes. Treatment dosage refers to the idea that treatment benefits are enhanced when clients have a greater number of practice trials during treatment. This hypothesis predicts that clients will show greater treatment effects when treatment sessions involve a small number of clients, because clients have many opportunities to practice target skills. Group dynamics refers to the hypothesis that working with a group of peers who have similar impairments leads to better treatment outcomes than working with smaller groups of clients, due to variables such as interpersonal learning. The proposed study will compare these hypotheses in the context of a well-motivated and operationalized conversational treatment. Across two sites, we will enroll 48 participants with chronic aphasia due to a stroke in the language-dominant hemisphere. All participants will be randomly assigned to one of three conditions: dyad treatment (2 clients per session), traditional group treatment (8 clients per session) or delayed control group. Treatment will occur for 60 minutes, twice a week for 10 weeks. During treatment sessions, a speech pathologist will facilitate discourse using linguistic and multimodal cueing hierarchies, which will be tailored to individual client goals. The primary outcome measure will evaluate how efficiently individuals with aphasia communicate information during a picture description task. Additional outcome measures will include standardized tests and patient reported outcome measures, which evaluate both changes in real-world communication ability and in social isolation. We will examine treatment effects associated with dyads and traditional groups immediately after treatment and one year after treatment, in order to determine whether treatment effects persist over time. This is a significant contribution because it will advance knowledge regarding how to optimize treatment for individuals with chronic aphasia. This study also provides the foundation for a research program that will systematically examine conversational treatment, including how differences in the treatment and individual (e.g., aphasia severity) influence treatment outcomes.