Adapting acceptance and mindfulness-based behavior therapy for stroke survivors with aphasia to improve communication success, post-stroke adaptation, and quality of life

对患有失语症的中风幸存者采用接受和基于正念的行为疗法，以提高沟通成功率、中风后适应和生活质量

• 批准号: 10380602
• 负责人: William Streicher Evans
• 金额: $ 15.88万
• 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: 2021-04-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10380602
• 关键词: Acquired Language Disorders; Address; Adherence; Affect; Aftercare; Alzheimer' s Disease; Amyotrophic Lateral Sclerosis; Aphasia; Behavior Therapy; Brain Injuries; Caregivers; Client; Client satisfaction; Clinical Trials; Communication; Counseling; Cues; Distress; Educational process of instructing; Employee; Evaluation; Feedback; Feeling; Financial compensation; Fright; Funding; Future; Gestures; Health; Health Professional; Intervention; Interview; Judgment; Language; Language Disorders; Life; Malignant Neoplasms; Manuals; Measures; Mental Health; Mission; Outcome; PF4 Gene; Participant; Pathologist; Persons; Pilot Projects; Population; Process; Psychosocial Factor; Public Health; Quality of life; Questionnaires; Rehabilitation therapy; Reporting; Speech; Stroke; Stuttering; Subgroup; Sum; Survivors; Techniques; Training; Underserved Population; United States; Value of Life; Vulnerable Populations; Work; Writing; acceptability and feasibility; alternative communication; aphasia recovery; aphasia rehabilitation; base; cohort; design; effective intervention; efficacy study; efficacy trial; emotional distress; evidence base; flexibility; improved; iterative design; meetings; mindfulness; post stroke; power analysis; psychologic; psychological distress; psychosocial; psychosocial adjustment; recruit; response; skills; stroke survivor; stroke therapy; stroke-induced aphasia; success; therapy design

1 Post-stroke Aphasia has profound and lasting negative effects on health-related quality 2 of life. Aphasia is a language disorder caused by acquired brain injury that affects 30-40% of 3 stroke survivors and more than 2.5 million people in the United States. For stroke survivors with 4 aphasia, their psychosocial response to sudden and unexpected loss of language can inhibit or 5 promote their ability to adapt and adjust post stroke. There is currently a critical need to better 6 address psychosocial factors in aphasia rehabilitation and recovery. 7 To meet this need, the current pilot project seeks to adapt Acceptance and Commitment 8 Therapy (ACT) for stroke survivors with aphasia by integrating language compensation training. 9 ACT is a behavioral intervention designed to improve psychological flexibility, allowing people to 10 take meaningful action consistent with their values, even in the presence of emotional distress. 11 ACT is an ideal intervention for aphasia, as it promotes a more flexible response repertoire that 12 relies less on verbal communication while reducing self-critical judgments and unhelpful thought 13 processes. Furthermore, Integrating ACT and language compensation training will be more 14 than the sum of its parts. Language compensation training is only effective when generalized 15 to often stressful real-world situations while ACT is only accessible to people with aphasia if 16 language needs are deliberately supported. However, while ACT is effective for stroke survivors 17 and people who stutter, no prior work has adapted ACT to meet the specific needs of 18 people with aphasia, thereby excluding a large and vulnerable subset of stroke survivors. 19 The objective of this proposal is to develop and refine an ACT for Aphasia treatment designed 20 to maximize communication participation, psychosocial adjustment, and quality of life for stroke 21 survivors with aphasia. Aim 1: Collaborate with a Stakeholder Advisory Board to develop 22 and refine an ACT for Aphasia treatment manual via an iterative design process. A two- 23 year sequential cohort design (n=21) will result in a comprehensive, stakeholder-driven 24 behavioral treatment. Aim 2: Establish intervention feasibility and acceptability. Feasibility 25 will be assessed through adherence, recruitment, participation, and completion. Acceptability 26 will be assessed via the Client Satisfaction Questionnaire-8. Preliminary effect sizes for 27 communication participation, psychosocial adjustment, and QoL will inform future clinical trials. 28 Developing ACT for Aphasia is directly aligned with the scope and mission of NCMRR, as it will 29 use a behavioral intervention to addresses the disabling consequences of living with post-stroke 30 aphasia, thereby better meeting the needs of this underserved subgroup of stroke survivors.

1后触诊后的失语症对与健康相关的质量产生深远而持久的负面影响 生命的2。失语症是一种因获得的脑损伤引起的语言障碍，影响了30-40％ 在美国，有3名中风幸存者和超过250万人。与中风幸存者一起 4失语症，他们对突然和意外语言丧失的社会心理反应会抑制或 5促进他们适应和调整中风后的能力。目前有迫切需要更好 6在康复和康复中解决心理社会因素。 7为了满足这种需求，当前的飞行员项目试图适应接受和承诺 8通过整合语言补偿培训，对中风幸存者的治疗（ACT）。 9 ACT是一种行为干预措施，旨在提高心理灵活性，使人们能够 10即使在存在情绪困扰的情况下，也采取有意义的行动与他们的价值观一致。 11 ACT是失语症的理想干预措施，因为它促进了更灵活的响应曲目 12较少依赖口头交流，同时减少自我批判性判断和无助的思想 13个过程。此外，整合行为和语言补偿培训将更多 14比其部分的总和。语言补偿培训仅在广义时有效 15经常强调现实世界中的情况，而行动只有失语症的人才能使用 16语言需求是故意支持的。但是，尽管行为对中风幸存者有效 17和口吃的人，没有事先的工作适应了以满足的特定需求 有18人失语症，因此排除了中风幸存者的大量脆弱的子集。 19该提案的目的是制定和完善设计的行为，以进行失语症治疗 20可最大化沟通参与，心理社会调整和中风的生活质量 21个失语症的幸存者。目标1：与利益相关者咨询委员会合作开发 22并通过迭代设计过程来完善一种用于失语治疗手册的ACT。两个 23年的顺序队列设计（n = 21）将导致全面的利益相关者驱动 24行为治疗。目标2：确定干预可行性和可接受性。可行性 25将通过遵守，招聘，参与和完成进行评估。可接受性 26将通过客户满意度调查表评估8。初步效应大小 27沟通参与，社会心理调整和QOL将为未来的临床试验提供信息。 28为失语症制定行为与NCMRR的范围和使命直接保持一致，因为它将 29使用行为干预措施来解决中风后生活的残疾后果 30失语症，从而更好地满足了这一中风幸存者的需求。