Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE) in Persons with Apraxia of Speech

中风后言语失用症(AOS)的治疗需要经常和持续的语音练习- 语言病理学家帮助持久的行为改变，这是昂贵的，因此，许多人无法获得 病人。因此，迫切需要找到新的、经济有效的方法来补充言语治疗 增加实践机会，优化治疗结果。我们的长期目标是开发一种 有效的、家庭实践的、基于计算机的运动成像方案[运动成像用于加强治疗 和有效性(MI-TEE)]，它将作为常规言语治疗的辅助手段，以优化治疗反应 在患有AOS的人中。本申请的总体目标是：(I)评估可接受性和可行性 将MI-TEE作为家庭练习计划，以及(Ii)确定MI-TEE与言语治疗的疗效，比较 仅靠语言治疗，就能改善AOS患者的言语产出。我们的中心假设是MI- TEE将是一种可接受的、可行的、有效的言语治疗辅助手段。为了达到我们的目标， 以下具体目标将使用两个具有多个基线的单一受试者实验设计来实现 跨参与者(n=18)：1)评估MI-TEE作为言语治疗辅助手段的可接受性和可行性 用于AOS的康复；以及2)比较辅助MI-TEE加标准言语疗法与 光是标准的语言治疗。在第一个目标下，观察数据、调查和半结构化访谈 将用于评估可接受性(感知的满意度、适当性和继续使用的意图) 以及MI-TEE的可行性(招募、保留和干预依从率)。对于第二个目的， 训练单词和未训练单词(泛化)的发音的准确性将在处理前被测量， 在治疗阶段和治疗后反复进行。语音精确度的提高将是 使用二进制评分系统进行记录(正确/不正确)。将使用多水平分析来处理比率 不同参与者之间的获取、总体变化和响应差异。建议的研究具有创新性。 因为它专注于建立一种工具，为患有以下疾病的人增加目标刺激的独立练习 以可获得和廉价的方式提供AOS。到目前为止，AOS的循证治疗结果 已经在受控实验室或临床环境中进行了检查。现在有了强有力的证据来支持 为了从这些治疗中获益，必须优化结果，并提供更经济和更容易获得的治疗 练习机会。拟议的研究具有重要意义，因为它有望成为 一项更大的临床试验(R01)，实施MI-TEE以提高AOS患者的治疗反应。具体来说， 这一研究将产生一种可获得的有效工具，将提供更多的机会 提高治疗反应和降低与频繁的面对面语言治疗相关的成本的做法。 这一系列研究的预期成果涉及NIDCD的优先领域：(领域3)改进 治疗人类交流障碍和(领域4)改善人类交流的结果。

Treatment of post-stroke apraxia of speech (AOS) requires frequent and ongoing practice with a speech- language pathologist to facilitate lasting behavioral change, which is costly and, therefore, inaccessible to many patients. Thus, there is a critical need to identify novel, cost-effective ways to supplement speech therapy to increase opportunities for practice and optimize treatment outcomes. Our long-term goal is to develop an effective, home-practice, computer-based, motor imagery protocol [Motor Imagery for Treatment Enhancement and Efficacy (MI-TEE)] which will serve as an adjunct to routine speech therapy to optimize treatment response in persons with AOS. The overall objectives of this application are to (i) evaluate the acceptability and feasibility of MI-TEE as a home practice program and (ii) determine the efficacy of MI-TEE with speech therapy, compared to speech therapy alone, in improving speech production in people with AOS. Our central hypothesis is that MI- TEE will be an accessible, feasible, and efficacious adjunct to speech therapy. To attain our objectives, the following specific aims will be pursued using two single-subject experimental designs with multiple baselines across participants (n=18): 1) Evaluate the acceptability and feasibility of MI-TEE as an adjunct to speech therapy for the rehabilitation of AOS; and 2) Compare the efficacy of adjunctive MI-TEE plus standard speech therapy to standard speech therapy alone. Under the first aim, observational data, surveys, and semi-structured interviews will be employed to assess the acceptability (perceived satisfaction, appropriateness, and intent to continue use) and feasibility (recruitment, retention, and intervention adherence rates) of MI-TEE. For the second aim, accuracy of articulation for trained words and untrained words (generalization) will be measured pre-treatment, repeatedly during the treatment phase, and post-treatment. Improvements in speech accuracy will be documented using a binary scoring system (correct/incorrect). Multilevel analyses will be used to address rate of acquisition, overall change, and response variation across participants. The proposed research is innovative because it focuses on establishing a tool for increasing independent practice of target stimuli for people with AOS in an accessible and inexpensive manner. Until now, outcomes for evidence-based treatments for AOS have been examined in controlled laboratory or clinical settings. Now that strong evidence exists to support the benefit of these treatments, it is imperative to optimize outcomes and provide more economical and accessible practice opportunities. The proposed research is significant because it is expected to serve as the foundation for a larger clinical trial (R01) implementing MI-TEE to advance treatment response in people with AOS. Specifically, this line of research will yield an accessible and efficacious tool that will provide additional opportunities for practice to enhance treatment response and reduce costs associated with frequent in-person speech therapy. The anticipated outcomes from this line of research address NIDCD’s Priority Areas: (Area 3) to improve treatment of disorders of human communication and (Area 4) to improve outcomes for human communication.