Overcoming Learned Non-Use in Chronic Aphasia: Behavioral, fMRI, and QoL Outcomes

克服慢性失语症的习得性不使用：行为、功能磁共振成像和生活质量结果

• 批准号: 8602517
• 负责人: Jacquie Kurland
• 金额: $ 35.14万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-02-11 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8602517
• 关键词: Affect; Aphasia; Behavior; Behavioral; Brain; Broca Aphasia; Case Series; Chronic; Computers; Data; Environment; Expressive Aphasia; Family; Functional Magnetic Resonance Imaging; Gestures; Goals; Health; Healthcare; High Prevalence; Home environment; Human Characteristics; Impairment; Incidence; Individual; Investigation; Knowledge; Language; Language Disorders; Language Therapy; Learning; Lesion; Life; Life Expectancy; Linguistics; Maintenance; Measurable; Measures; Methodology; Mission; Modality; Names; Neuronal Plasticity; Outcome; Overlearning; Participant; Patients; Pattern; Perception; Persons; Population; Public Health; Quality of life; Randomized; Recovery; Rehabilitation therapy; Research; Schedule; Services; Severities; Site; Speech; Stroke; Structure; System; Testing; Therapeutic; Time; Training; Treatment Protocols; Work; Writing; aphasia rehabilitation; aphasic; base; brain behavior; disability; experience; follow-up; improved; innovation; lexical; neural patterning; neuroimaging; neuromechanism; neurophysiology; post stroke; programs; psychosocial; remediation; response; social; treatment duration; treatment program; treatment response

DESCRIPTION (provided by applicant): Despite recent evidence demonstrating treatment-induced neuroplasticity in chronic aphasia, questions remain regarding the influence of treatment variables on language recovery, the neural mechanisms supporting such recovery, and evidence of measurable, correlated improvements in quality of life (QoL). The long-range goal of the proposed study is to better understand how treatment variables affect recovery in chronic aphasia, including the brain/behavior mechanisms supporting improved naming, and how such improvements impact QoL. The current objective is: first, to determine whether intensive treatment for remediation of word-finding deficits is effective for persons with moderate-to-severe expressive aphasia, regardless of speech practice; second, to identify signature neural patterns of treatment-induced improvements in naming; and third, to characterize the relationship between improved language ability and QoL within affected families. The current study proposes a longitudinal case series approach to aphasia rehabilitation, focusing on the effect of one variable, implicit vs. explicit treatment, on linguistic, neurophysiological, and psychosocial changes in chronic moderate-to-severe patients. The three specific aims are: 1) To determine whether gains in naming following constraint-induced language therapy (CILT) exceed those observed following unconstrained language therapy (ULT), over and above type and severity of aphasia, and whether the gains can be maintained over time. The central hypothesis is that participants, even those with persistent severe nonfluent aphasia and co-morbid apraxia of speech, will benefit from both intensive treatment programs, with significant gains in those randomly assigned to CILT. Words that are trained and practiced (i.e., "overlearned") following CILT and ULT will show better maintenance in 12-month follow-up testing; 2) To characterize patterns of fMRI activation that correlate with improved picture naming. The working hypothesize is that improved naming correlates with modulation of spared networks that vary according to site/extent of lesion; and 3) To quantify the degree to which improvements following short-term intensive language therapy correlate with changes in QoL measures as perceived by both participants with aphasia and their significant others. Preliminary data suggest that improved naming can "jumpstart" language systems caught in learned non-use and stimulate behavioral changes in factors known to correlate with QoL, e.g., confidence, social relationships, and independence. This research is innovative, first because of the three-pronged (behavioral, neuroimaging, QoL) longitudinal case series approach and its potential to demonstrate meaningful long-term changes resulting from short-term, intensive treatment plus a maintenance home therapy program, and second, because it focuses, in part, on a more severely affected population than is customarily studied. This contribution is significant because advancing our knowledge of the true anatomical, functional, and behavioral limits and potential for post-stroke language recovery could influence perceptions that affect delivery of services to chronically aphasic persons.

描述（由申请人提供）：尽管最近有证据表明治疗引起的慢性失语症的神经可塑性，但有关治疗变量对语言恢复的影响，支持这种恢复的神经机制以及可测量的，生活质量改善的证据（QOL）的问题。拟议的研究的远程目标是更好地了解治疗变量如何影响慢性失语症的恢复，包括支持改善命名的大脑/行为机制，以及这种改善如何影响QOL。目前的目标是：首先，确定对辅助识别缺陷进行补救的强化治疗方法是否对中度至重度表达性失语症的人有效，无论言语实践如何；第二，确定治疗引起的命名改善的签名神经模式；第三，要表征受影响家庭内部的语言能力和质量质量之间的关系。当前的研究提出了一种纵向案例系列方法，以进行失语症康复，重点介绍一种变量，隐式与显式治疗的影响，对慢性中度到社会患者的语言，神经生理学和社会心理变化。这三个具体目的是：1）确定命名命名后的收益是否超过了不受约束的语言治疗（ULT）（EULT），超过和更高的失语性和严重性以及是否可以随着时间的推移维持收益。中心假设是，参与者，即使是那些持续的严重非流行性失语症和言语合并化失用的参与者，都将受益于这两种强化治疗计划，在随机分配给cill的人中有了显着增长。在CILT和ULT之后经过训练和实践的单词（即“过度处理”）将在12个月的随访测试中显示出更好的维护； 2）表征fMRI激活的模式，与改进的图片命名相关。假设的工作是，改进的命名与根据病情的部位/范围变化的储蓄网络的调制相关。 3）为了量化短期强化语言治疗后的改进与QOL措施的变化相关的程度，同时两位失语症及其重要的参与者都认为。初步数据表明，改进的命名可以“跳动”语言系统，以学习的不使用，并刺激已知与QOL相关的因素的行为变化，例如信心，社会关系和独立性。这项研究具有创新性，首先是由于三管齐下（行为，神经影像，QOL）纵向案例系列方法及其潜力，其潜力证明了由于短期，强化治疗以及维护家庭治疗计划而产生的有意义的长期变化，其次，其部分是因为它部分集中在比惯例更严重的人群上。这项贡献是重要的，因为促进我们对真正解剖，功能和行为限制以及中风后语言恢复的潜力的了解可能会影响影响为慢性失语者提供服务的看法。