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 中风后失语症对健康相关质量具有深远而持久的负面影响 2. 生活。失语症是一种由后天性脑损伤引起的语言障碍，影响 30-40% 的人 美国有 3 名中风幸存者和超过 250 万人。对于中风幸存者 4 失语症，他们对突然和意外丧失语言的心理社会反应可以抑制或 5.提高中风后的适应和调整能力。当前迫切需要更好地 6 解决失语症康复和恢复中的心理社会因素。 7 为了满足这一需求，当前的试点项目力求调整接受和承诺 8 通过整合语言补偿训练对患有失语症的中风幸存者进行治疗 (ACT)。 9 ACT 是一种行为干预措施，旨在提高心理灵活性，让人们能够 10 即使存在情绪困扰，也会采取符合其价值观的有意义的行动。 11 ACT 是失语症的理想干预措施，因为它可以促进更灵活的反应体系， 12 减少对口头交流的依赖，同时减少自我批评的判断和无益的想法 13道工序。此外，将ACT与语言补偿培训相结合将更加有效。 14 大于其各部分之和。语言补偿训练只有在普遍化时才有效 15 现实世界中经常充满压力的情况，而 ACT 仅适用于失语症患者，如果 特意支持 16 种语言需求。然而，虽然 ACT 对中风幸存者有效 17 和口吃者，之前没有任何工作使 ACT 能够满足他们的特定需求 18 名患有失语症的人，从而排除了一大批脆弱的中风幸存者。 19 该提案的目标是开发和完善旨在治疗失语症的 ACT 20 最大限度地提高中风患者的沟通参与、心理社会调整和生活质量 21名幸存者患有失语症。目标 1：与利益相关者咨询委员会合作开发 22 并通过迭代设计流程完善 ACT 失语症治疗手册。一个二- 23 年序贯队列设计 (n=21) 将产生全面的、利益相关者驱动的 24 行为治疗。目标 2：建立干预措施的可行性和可接受性。可行性 25 将通过遵守、招募、参与和完成进行评估。可接受性 26 将通过客户满意度调查问卷 8 进行评估。初步效应量 27 沟通参与、心理社会调整和生活质量将为未来的临床试验提供信息。 28 开发针对失语症的 ACT 与 NCMRR 的范围和使命直接相关，因为它将 29 使用行为干预来解决中风后生活造成的残疾后果 30 失语症，从而更好地满足这一服务不足的中风幸存者亚群的需求。