Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia

定义失语症的语言、认知交际和生活质量结果的轨迹

• 批准号: 10376798
• 负责人: Leora R Cherney
• 金额: $ 57.23万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-10 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10376798
• 关键词: Admission activity; Adult; Affect; Agreement; Aphasia; Biological Markers; Brain; Brain-Derived Neurotrophic Factor; Caregivers; Caring; Characteristics; Clinical; Clinical Treatment; Cognitive; Communication; Decision Making; Dose; Fibrinogen; Functional Magnetic Resonance Imaging; Genetic Markers; Genetic Polymorphism; Goals; Growth; Health; Health Care Costs; Heterogeneity; Hospitals; Individual; Inpatients; Language; Language Therapy; Length of Stay; Lesion; Life; Linguistics; Location; Longitudinal cohort study; Measurement; Measures; Methodology; Methods; Modeling; Monitor; Neurobiology; Neuronal Plasticity; Outcome; Outcome Measure; Outpatients; Participant; Pathology; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Persons; Predictive Factor; Prevalence; Productivity; Prospective Studies; Prospective cohort; Public Health; Quality of life; Recovery; Rehabilitation therapy; Rest; Sampling; Services; Severities; Speech Therapy; Standardization; Stroke; Survivors; System; Testing; Treatment Factor; Variant; Work; aphasia recovery; clinical practice; cohort; cost; design; functional gain; gene therapy; health related quality of life; improved; improved outcome; innovation; instrument; nervous system disorder; neuroimaging marker; patient oriented; post stroke; programs; prospective; recruit; rehabilitation service; response; service delivery; sound; stroke patient; stroke rehabilitation; stroke therapy; stroke-induced aphasia

Stroke imposes significant burdens on the health and quality of life of survivors and their caregivers, and presents a major public health issue in terms of healthcare costs and lost productivity. Aphasia adds to the cost of stroke- related care. Many stroke survivors with aphasia receive therapy in inpatient rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of inpatient rehabilitation on outcomes. The objective of this study is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (QoL) outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilita- tion to 18 months following stroke. A sampleof 300 consecutively-admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological Disorders (Neuro-QoL) Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We will model outcomes as individual and group trajectories, allowing us to develop individual predictions which could inform clinical planning and decision-mak- ing for new patients. The Specific Aims are to: Aim 1: Establish a prospective cohort of stroke patients with aphasia, and define their typical trajectory of lin- guistic, cognitive-communicative, and health-related QoL recovery at admission to and discharge from the IRF, and at 6, 12, and 18 months post onset. Aim 2: Identify factors that are associated with linguistic, cognitive-communicative, and health-related QoL out- comes from among the following: patient factors including demographic and clinical characteristics related to stroke and aphasia; treatment variables including inpatient and outpatient aphasia therapy characteristics and informal aphasia services; and biomarkers, including genetic and neuroimaging biomarkers. Aim 3: Evaluate the stability of the models of linguistic, cognitive-communicative, and health-related QoL out- comes recovery that are developed from Aims 1 and 2. This study is innovative in its use of (1) standardized assessments that measure not only linguistic outcomes but also communication and QoL outcomes; (2) patient-centered, self-report instruments such as Neuro-QoL to de- tect clinically important change through 18 months post-stroke; (3) individual growth curve analysis to describe recovery trajectories and examine associations between demographic, lesion, aphasia, genetic, and speech and language therapy characteristics; (4) biomarkers that have been implicated in promoting neuroplasticity; (5) rest- ing state functional magnetic resonance imaging to evaluate the association between network pathology and recovery from aphasia; (6) information on type, amount, and duration of aphasia treatment provided in clinical settings; and (7) information on informal aphasia services following discharge from formal therapy.

中风对幸存者及其照顾者的健康和生活质量施加了巨大的负担，并给予礼物 关于医疗保健成本和生产力失去的主要公共卫生问题。失语症增加了中风的成本 - 相关护理。许多失语症的中风幸存者在住院康复设施中接受治疗。然而， 失语症的恢复是可变的，并且证据证明了住院康复对结局的好处。 这项研究的目的是描述语言，认知传播和与健康有关的轨迹 生活质量（QOL）在住院和门诊治疗期间失语症患者中风后的结果（QOL） - 中风后的18个月。招募了300名连续添加的中风患者的样本 在三家中西部康复医院将完成语言和认知交流的措施 性能以及神经系统疾病的生活质量（Neuro-QOL）测量系统仪器 在康复期间以及中风后6，12和18个月。我们将作为个人和小组的成果建模 轨迹，使我们能够制定个人预测，这些预测可以为临床计划和决策提供信息 为新患者。具体目的是： 目标1：建立失语症的中风患者的前瞻性队列，并定义其典型的lin-轨迹 入院和从IRF出院时，Guistic，认知交流和与健康相关的QOL恢复， 并在发病后6、12和18个月。 AIM 2：确定与语言，认知交流和与健康相关的QOL相关的因素 来自以下内容：患者因素包括人口统计和临床特征 中风和失语症；治疗变量，包括住院和门诊失语症疗法特征和 非正式失语症服务；和生物标志物，包括遗传和神经影像学。 AIM 3：评估语言，认知交流和与健康相关的QOL模型的稳定性 从目标1和2开发的恢复。 这项研究是创新的（1）标准化评估，不仅衡量语言结果，而且衡量 也可以进行沟通和质量结果； （2）以患者为中心的自我报告工具，例如神经QOL 在冲程后18个月内进行临床上重要的变化； （3）个体生长曲线分析以描述 恢复轨迹并检查人口，病变，失语症，遗传和言语与语音之间的关联 语言疗法特征； （4）与促进神经可塑性有关的生物标志物； （5）休息 - ING状态功能磁共振成像，以评估网络病理与 从失语症中恢复； （6）有关临床中提供的类型，数量和持续时间的信息 设置; （7）正式疗法出院后有关非正式失语症服务的信息。