Developing a Novel Cognitive-Behavioral Intervention for Psychosocial Rehabilitation in Chronic Stroke

中风是一种神经损伤，对心理社会功能和生活质量产生不利影响。今年5月 由于直接侮辱适应性心理社会功能的神经回路底物而发生，和/或间接 通过严重扰乱日常运动、感觉和认知能力。例如，后遗症 中风往往会促使角色改变，以及相关的职业和经济压力，这可能会产生深远的影响 对中风幸存者及其亲人日常功能的影响。这很可能不仅发生在急性 中风的后果，但也在慢性阶段，当损害的潜在持久性变得明显时。 虽然中风后运动和感觉障碍的康复干预措施已经确立，但相对 认知障碍的治疗选择很少。除了中风后抑郁，几乎没有循证证据 存在解决情绪和人际功能的广泛干扰的干预措施 具体到中风，突出了一个明显的未得到满足的需求。我们认为适应性心理社会功能 中风后可能对整体生活质量特别重要，但对坚持身体健康也特别重要。 旨在促进全面恢复的康复和相关干预措施。 这一研究的长期目标是建立一种有效的、以证据为基础的、认知的-- 行为干预对退伍军人慢性脑卒中心理社会康复的影响 生活质量和功能独立性。这一系列研究的短期目的是严格地 建立受慢性中风最不利影响的心理社会功能领域，并制定 认知行为干预(CBT)是为解决相应的心理社会障碍而量身定做的， 最终可单独提供或作为身体康复的辅助手段。重要的是，我们还 建议这种干预措施对患有慢性阻塞性肺病的退伍军人最为适用和有效 如果CBT模块不关注精神疾病的共病诊断，而是专注于 中风后的社会心理障碍。退伍军人医疗保健系统是传播 基于证据的CBT，已经配备了精神卫生保健提供者，他们是专家，特别是在 对压力源和创伤的心理社会适应。因此，可扩展的、远程的、卒中后定制的CBT 干预措施可以在退伍军人管理局医疗系统内轻易实施。 为了推进这一新的工作路线，我们建议作为目标1，通过VA Video Connect(VVC)完成单个、 对1)老年慢性卒中幸存者(n=50)、2)他们所爱的人进行横断面定性评估 一名/护理者(n=25)，以及3)退伍军人中风康复提供者(例如，身体、语言和职业 治疗师、神经病学家、神经心理学家；n=25)。对于相对于规范的量化的表征 完成Aim1定性访谈的度量值、退伍军人(n=50)和亲人(n=25)也将 心理社会功能的完整量化测量(目标2)。在目标3中，将开发基于内容的测试模块 (8-10，30-45分钟模块)，并通过VVC部署给患有慢性中风的退伍军人(n=10)。 我们假设，已确定的领域将包括一系列通常未在 中风的身体康复和与中风后调整相关的包括：情绪功能(压力， 对可观察到的障碍的焦虑，应对)，睡眠，行为激活，育儿，亲密关系， 物质使用。我们还希望举报人在损害最严重的领域保持一致， 从而促进确定有成效的干预候选者。我们进一步假设，简短的CBT 负责中风康复和心理社会功能交集的模块将被视为 重要，被评为可接受和可信的。综上所述，这些发现将从根本上揭示 并指出了一种以循证认知为基础的干预手段 行为技术，为慢性中风量身定做，在退伍军人管理局医疗系统中随时可扩展。

Stroke is a neurological injury that adversely impacts psychosocial functioning and quality of life. This may occur due to direct insult to the neurocircuit substrates of adaptive psychosocial functioning, and/or indirectly via significant disruption to routine motor, sensory and cognitive performance. For example, the sequelae of stroke often prompt role changes, and associated occupational and financial strain that could have profound impact on the daily functioning of stroke survivors and their loved ones. This is likely not only in the acute aftermath of stroke, but also in the chronic stage when the potential durability of impairments becomes clear. While rehabilitation interventions for post-stroke motor and sensory impairments are well established, relatively few options exist for cognitive impairment. With the exception of post-stroke depression, few evidence-based interventions exist for addressing the broad disruption to emotional and interpersonal functioning specific to stroke, highlighting a clear unmet need. We propose that adaptive psychosocial functioning post-stroke is likely particularly important for overall quality of life, but additionally for adherence to physical rehabilitation and related interventions intended to promote holistic recovery. The long-term purpose of this line of research is to establish an efficacious, evidence-based, cognitive- behavioral intervention for psychosocial rehabilitation in chronic stroke toward optimally enhancing Veteran quality of life and functional independence. The short-term purpose of this line of research is to rigorously establish the domains of psychosocial functioning most adversely impacted by chronic stroke and to develop a cognitive-behavioral intervention (CBT) tailored to addressing corresponding psychosocial impairments, which could ultimately be delivered alone or adjunctively to physical rehabilitation. Importantly, we additionally propose that such an intervention would be most broadly applicable and effective for Veterans with chronic stroke if CBT modules did not focus on comorbid diagnoses of mental illness, but rather focused on domains of post-stroke psychosocial impairment. The VA Healthcare System is a world leader in the dissemination of evidence-based CBT and is already staffed with mental healthcare providers who are experts, particularly in psychosocial adjustment to stressors and trauma. Thus, a scalable, remote, post-stroke tailored CBT intervention could be readily implemented within the VA Healthcare System. To forward this novel line of work, we propose as Aim 1, to complete via VA Video Connect (VVC) a single, cross-sectional qualitative assessment of 1) Veteran chronic stroke survivors (n=50), 2) their loved ones/caregivers (n=25), and 3) VA stroke rehabilitation providers (e.g., physical, speech, and occupational therapists, neurologists, neuropsychologists; n=25). For characterization relative to normed quantitative measures, Veterans (n=50) and loved ones n=25) who complete qualitative interviews from Aim1 will also complete quantitative measures of psychosocial functioning (Aim 2). In Aim 3, CBT modules will be developed (8-10, 30-45 minute modules) and deployed via VVC with Veterans with chronic stroke (n=10). We hypothesize that identified domains will include a range of psychosocial domains typically not addressed in stroke physical rehabilitation and related to post-stroke adjustment including: emotional functioning (stress, anxiety about observable impairments, coping), sleep, behavioral activation, parenting, intimate relationships, substance use. We also expect concordance across informants regarding domains of greatest impairment, thus facilitating identification of productive candidates for intervention. We further hypothesize that brief CBT modules that attend to the intersection of stroke recovery and psychosocial functioning will be deemed important and rated as acceptable and credible. Taken together, these findings will foundationally inform on psychosocial functioning in chronic stroke and point to a means of intervening with evidence-based cognitive- behavioral techniques, tailored to chronic stroke and readily scalable in the VA Healthcare System.