Determinants of multilevel discourse outcomes in anomia treatment for aphasia

失语症贫血治疗中多层次话语结果的决定因素

• 批准号: 10314137
• 负责人: Robert Cavanaugh
• 金额: $ 3.42万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314137
• 关键词: Anomia; Aphasia; Archives; Attention; Bayesian Analysis; Brain Injuries; Clinical; Clinical effectiveness; Cognitive; Communication; Comparative Effectiveness Research; Cues; Development; Discourse analysis; Effectiveness; Enrollment; Episodic memory; Evaluation; Funding; Goals; Heterogeneity; Human; Impairment; Individual; Individual Differences; Influentials; Language; Language Disorders; Life; Linguistics; Measurement; Measures; Memory; Mentorship; Modeling; Motivation; Names; Outcome; Outcome Measure; Pattern; Performance; Probability; Research; Resolution; Retrieval; Risk; Role; Sampling; Scientist; Semantic memory; Semantics; Shoes; Structure; Training; Translational Research; Treatment outcome; United States; Validation; Walking; Work; base; career; clinical implementation; cognitive process; common treatment; disability; evidence base; executive function; follow-up; improved; lexical; multilevel analysis; phonology; psychosocial; response; restorative treatment; statistics; syntax; treatment effect

Communication is fundamental to the human condition but is impaired in life-altering ways for more than 2.4 million people with aphasia (PWA) in the United States.1 PWA identify discourse-level communication (i.e. language in use) as a high priority for treatment.2 The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse.3 However, treatment-related discourse outcomes are modest, poorly understood, and vary greatly between PWA.4,5 In response, this proposal will investigate mechanisms of action and cognitive predictors of multilevel discourse outcomes in Semantic Feature Analysis (SFA). While SFA is one of the most common treatments for aphasia,6–8 it is unclear how SFA improves discourse-level communication, and for whom.9 SFA improves word-level communication by (a) spreading activation across semantic networks,10 thus improving word-finding ability (restorative mechanism) and/or (b) training self-cueing and strategic responses to instances of anomia, thus improving language use (compensatory mechanism).11–13 Preliminary analysis found that intensive SFA improved the informativeness14 of discourse overall, and for 19/44 PWA (5I01RX000832-05, MPI: Dickey). However, informativeness alone cannot differentiate which mechanism(s) are responsible for discourse generalization in SFA. This study proposes a multilevel discourse analysis15,16 of archival discourse outcomes across two high- intensity SFA studies (5I01RX000832-05 and 1R01DC017475-01A1; combined n = 60). Multilevel discourse measures include: semantic and verbal paraphasias, predicate-argument structure, lexical diversity, informativeness, and global coherence.16,17 Aim 1 will evaluate the role of restorative and compensatory mechanisms on multilevel discourse outcomes. Patterns of correspondence and non-correspondence across discourse outcome measures will delineate the role of restorative and compensatory mechanisms in treatment-related discourse improvements. Aim 2 will examine cognitive predictors of multilevel discourse outcomes: semantic memory, episodic memory, attention, and executive function. Examining the relationships between cognitive factors and discourse outcome measures will establish how each cognitive process supports 1) restorative and/or compensatory mechanisms and 2) improvements at multiple levels of discourse. The proposed study has the potential to improve the clinical effectiveness and implementation of SFA by determining how and for whom SFA improves discourse-level communication. Ultimately, improving discourse- level communication may help to reduce the profound communication and psychosocial consequences of aphasia. This proposal will integrate training in discourse analysis, multivariate statistics, comparative effectiveness research, and professional development to accelerate the applicant’s independence as a clinician- scientist in pursuit of his long-term research goal: improving everyday communication outcomes via theoretically-grounded, translational research.

沟通是人类状况的基础 在美国，有百万失语症（PWA）的人。1PWA确定了话语级的沟通（即 使用中的语言）作为治疗的重点。2大多数失语症治疗的中心前提是恢复 音素，单词和/或句子级别的语言将概括为话语。3然而，与治疗有关 话语结果谦虚，理解不足，在PWA.4,5之间有很大差异。 将研究语义中多级话语结果的作用机理和认知预测指标 功能分析（SFA）。虽然SFA是失语症最常见的治疗方法之一，但6-8尚不清楚SFA如何 改善话语级别的沟通，并为谁提供。9SFA通过（a）改善了文字级别的沟通 跨语义网络传播激活，10提高了单词调查能力（恢复机制） 和/或（b）培训对异常情况的自我提示和战略反应，从而改善语言使用 （补偿机制）.11–13初步分析发现，密集的SFA提高了信息性14 总体话语，对于19/44 PWA（5I01RX000832-05，MPI：Dickey）。但是，仅提供信息 无法区分哪些机制负责SFA中的话语概括。 这项研究提出了多层次的话语分析15,16的档案讨论结果 强度SFA研究（5I01RX000832-05和1R01DC017475-01A1;组合n = 60）。多级话语 措施包括：语义和言语易感，谓词题目结构，词汇多样性， 信息性和全球连贯性。16,17AIM 1将评估恢复性和补偿性的作用 多级话语结果的机制。对应的模式和非对应的模式 跨话的结果措施将描述恢复性和补偿机制的作用 与治疗相关的话语改进。 AIM 2将检查多级话语的认知预测指标 结果：语义记忆，情节记忆，注意力和执行功能。检查关系 在认知因素和话语结果度量之间将确定每个认知过程如何支持 1）恢复性和/或补偿机制以及2）在多个话语中的改进。 拟议的研究有可能提高SFA的临床有效性和实施 确定SFA如何以及为谁改善话语级别的沟通。最终，改善话语 - 水平沟通可能有助于减少深刻的沟通和社会心理后果 失语症。该建议将在话语分析，多元统计，比较中整合培训 有效性研究和专业发展，以加速申请人的独立性作为临床 科学家追求他的长期研究目标：通过 理论上的翻译研究。