Transferring Speed of Processing Gains to Everyday Cognitive Tasks after Stroke

将中风后处理速度的提高转移到日常认知任务中

• 批准号: 10480911
• 负责人: KARLENE K BALL
• 金额: $ 59.83万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-05 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10480911
• 关键词: Address; Adult; Affect; Aftercare; Automobile Driving; Basic Science; Behavioral; Caregivers; Caring; Cognition; Cognitive; Cognitive deficits; Communities; Data; Dementia; Disease; Elderly; Evaluation; Exhibits; Family member; Impaired cognition; Impairment; Individual; Intervention; Laboratories; Life; Measurement; Measures; Methods; Modeling; Motor; Movement; Outcome; Participant; Patient Care; Patients; Performance; Persons; Prevalence; Procedures; Process; Quality of life; Randomized Controlled Trials; Rehabilitation therapy; Research; Research Personnel; Research Proposals; Sample Size; Sampling; Savings; Signal Transduction; Site; Speed; Stroke; Task Performances; Techniques; Testing; Training; Work; arm; base; blood oxygenation level dependent response; care costs; caregiving; chronic stroke; cognitive ability; cognitive function; cognitive rehabilitation; cognitive task; cost; design; experience; follow-up; improved; improved functioning; information processing; instrumental activity of daily living; new combination therapies; novel; post stroke; post stroke cognitive impairment; processing speed; stroke patient; therapy design; treatment effect

ABSTRACT Many individuals with cognitive impairment experience decrements in everyday function that can signal encroaching dementia. For every year that cognitive decline is delayed there is substantial savings in patient care costs and inestimable savings in quality of life for patients and family members. The prevalence of cognitive impairment in chronic stroke is approximately 50%. A number of techniques have been found to improve various aspects of cognition in the training situation. However, their transfer to everyday situations outside the training setting has been limited as is retention. They are therefore of reduced or narrow practical value. A cognitive ability that is improved but not used to enhance real-world performance has limited significance. Pilot work has been carried out here with a novel intervention designed to fill these crucial gaps. The results are very promising. The purpose of the proposed research is to carry out a randomized controlled trial (RCT) with a large enough sample to rigorously evaluate these preliminary results. The new treatment to be tested combines two repeatedly validated rehabilitation methods: the Transfer Package of CI Movement Therapy and Speed of Cognitive Processing Training. The purpose of doing so is to produce a marked enhancement in the transfer of cognitive improvement from the training setting to instrumental activities of daily living (IADL) in everyday situations. Both halves of the new combination therapy are founded on the investigators' own basic research. In both cases, efficacy is supported by positive results from multiple single-site RCTs and a large multisite RCT. However, the effect of Speed of Processing Training has been found to have limited generalization to cognitive-based IADL in everyday situations. In contrast, one of the main strengths of CI Therapy is that it produces a robust and extensive transfer of treatment effect to everyday life situations by means, in part, of its Transfer Package. A second strength of the Transfer Package of CI Therapy is long-term retention of its effect. In our initial work, the Transfer Package procedures that this lab has used effectively to transfer motor gains from the treatment to everyday setting were adapted to transfer cognitive gains from the treatment to the everyday setting. We propose here an RCT with 2 arms: Speed of Processing Training (SOPT) in the lab combined with the TP (TP+) and SOPT in the lab but without the TP (TP-). Participants will be 120 adults more than 1-year post-stroke with mild to moderate cognitive impairment. Performance on cognitive-based tasks will be measured in daily life and in the lab before and after baseline, after treatment, and 6- and 12-months afterwards. This design will permit rigorous testing of the value of the Transfer Package with an adequate sample size, objective measurement, blinding, and between-subjects control for amount and intensity of training and therapist contact.

抽象的 许多患有认知障碍的人都会经历日常功能下降，这可能表明 痴呆症的侵袭。认知能力下降每延迟一年，患者就可以节省大量费用 护理成本并为患者及其家人的生活质量节省不可估量的费用。患病率 慢性中风的认知障碍约为 50%。已发现多种技术 在训练情境中提高各方面的认知。然而，他们转移到日常生活中 培训环境之外的培训和保留都受到限制。因此，它们的实用性有所减少或狭窄。 价值。认知能力得到改善但不用于提高现实世界的表现是有限的 意义。这里已经开展了试点工作，采用了旨在填补这些关键空白的新颖干预措施。 结果非常有希望。本研究的目的是进行随机对照研究 试验（RCT）有足够大的样本来严格评估这些初步结果。 待测试的新疗法结合了两种反复验证的康复方法：转移疗法 CI 运动疗法和认知处理速度训练套餐。这样做的目的是 显着增强认知改善从训练环境转移到 日常生活中的工具性日常生活活动（IADL）。新联合疗法的两部分 是建立在研究者自己的基础研究之上的。在这两种情况下，疗效均得到积极结果的支持 来自多个单中心随机对照试验和大型多中心随机对照试验。然而，处理速度训练的效果 人们发现，在日常情况下，基于认知的 IADL 的泛化能力有限。相比之下，一 CI 疗法的主要优点之一是它能将治疗效果强健而广泛地转移到患者身上。 日常生活情况部分地通过其转移包。转学套餐的第二个优势 CI疗法的特点是长期保留其效果。在我们最初的工作中，传输包程序 实验室已有效地将治疗中的运动增益转移到日常环境中，并适应于转移 从治疗到日常环境中的认知增益。 我们在这里提出一个有 2 个分支的随机对照试验：实验室中的处理速度训练 (SOPT) 与 实验室中有 TP (TP+) 和 SOPT，但没有 TP (TP-)。参与者将是 120 名 1 岁以上的成年人 中风后轻度至中度认知障碍。基于认知的任务的表现将 在基线前后、治疗后以及 6 个月和 12 个月的日常生活和实验室中进行测量 然后。这种设计将允许对传输包的价值进行严格的测试，并有足够的 样本量、客观测量、盲法以及受试者间控制的数量和强度 培训和治疗师联系。