Modulating stimulus intensity to improve clinical outcomes in aphasia treatment

调节刺激强度以改善失语症治疗的临床结果

• 批准号: 9974499
• 负责人: Leora R Cherney
• 金额: $ 64.99万
• 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: 2019-07-09 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974499
• 关键词: 3-Dimensional; Address; Affective; Aftercare; Aphasia; Behavior; Client; Clinical; Clinical Treatment; Cognitive Science; Communication impairment; Communities; Complex; Computer Models; Computers; Dose; Educational process of instructing; Effectiveness; Elements; Ensure; Environment; Frequencies; Goals; Home environment; In Situ; Individual; Intervention; Investigation; Larynx; Learning; Linguistics; Literature; Longevity; Maintenance; Measures; Modeling; Names; Neurologic; Neuronal Plasticity; Neurosciences; Outcome; Outcome Measure; Participant; Pattern; Personality; Persons; Privacy; Production; Reporting; Research; Response Generalization; Schedule; Secondary to; Speech Intelligibility; Stimulus; Stimulus Generalization; Tablets; Time; Training; Treatment Effectiveness; Wireless Technology; clinical application; clinical practice; computerized; cost; cost effective; design; effective therapy; improved; innovation; long-term rehabilitation; primary outcome; secondary outcome; sensor; sound; treatment arm; treatment program; virtual; visual speech

Abstract Determining the optimal intensity of treatment is essential to the design and implementation of any treatment program for aphasia. Yet, treatment intensity is a complex construct and information on the variables modulating it remain ambiguous and limited. Studies reported in the neuroscience and clinical literature support the need for intensive treatment to induce long-term neuroplastic changes while the cognitive psychology literature suggests that learning is best maintained with distributed schedules. A few studies have looked at dose parameters for single word naming tasks, but there is limited evidence regarding dose parameters for treatments that focus on training the production of larger units, such as sentences or even connected discourse. One approach that is frequently used clinically and has evidence for its efficacy is script training. Little is currently known regarding the optimum dose of script training (i.e., the number of repetitions over time of each sentence within the script) that is required to promote the best outcomes. In this proposal we conduct a two-factor RCT on the effects of modulating stimulus variables, specifically stimulus practice distribution and stimulus repetition. We use a baseline script treatment that has experimental support regarding its efficacy, and that allows the manipulation of these variables. To ensure independence and fidelity, treatment is provided in a controlled computer environment (desktop and tablet). To avoid clinician- related variables such as expertise and personality factors that may influence treatment, sentences are modeled during treatment by an anthropomorphic agent with high visual speech intelligibility and affective expressions. With regard to “best outcomes”, generalization is the ultimate goal of any treatment approach. Therefore, the primary outcome is a generalization measure of conversation. Secondary measures address short-term acquisition, longer-term maintenance, and response generalization for assessing gain over baseline, differential effects, and interactions. A mobile-connected wireless wearable laryngeal sensor allows tracking of talk time at home and in the community as a measure of treatment effectiveness and transfer. For privacy, it does not record audio. Results and computational models of learning (generalization, short-term acquisition, and longer-term maintenance) will contribute new evidence to fill critical gaps in current scientific understanding regarding the effectiveness and clinical application of aphasia treatment approaches. More generally, findings will help to inform clinical practice and treatment of neurologic communication disorders; the virtual clinician guided intervention that the proposal develops has the potential to reduce costly clinician-client time otherwise required for long-term rehabilitation. .

抽象的 确定最佳治疗强度对于设计和实施至关重要 失语症的治疗计划。然而，治疗强度是一个复杂的构造和有关变量的信息 调节它仍然模棱两可和有限。在神经科学和临床文献中报道的研究 支持对诱导长期神经塑性变化的深度治疗的需求 心理学文献表明，最好通过分布式时间表来维持学习。一些研究有 查看单词命名任务的剂量参数，但有关剂量的证据有限 专注于培训较大单位的生产的治疗参数，例如句子甚至 连接的话语。一种经常在临床上使用并有证据证明其有效性的方法是脚本 训练。目前，关于脚本培训的最佳剂量（即重复数量 随着脚本中每个句子的时间），这是促进最佳结果所需的。 在此提案中，我们对调节刺激变量的影响进行了两因素RCT，特别是 刺激练习分布和刺激重复。我们使用具有实验性的基线脚本处理 支持其有效性，并允许操纵这些变量。确保独立 富达，在受控的计算机环境（台式机和平板电脑）中提供处理。避免临床 相关变量，例如可能影响治疗的专业知识和人格因素，句子是 由具有高视觉语音清晰度和情感的拟人化剂在治疗期间建模 表达。 关于“最佳结果”，概括是任何治疗方法的最终目标。所以， 主要结果是对话的概括度量。次要措施解决短期 获取，长期维护和响应概括以评估基线的增益， 差异效果和相互作用。移动连接的无线可穿戴喉传感器允许跟踪 在家和社区中谈论时间，以衡量治疗效率和转移。为了隐私，它 不记录音频。 结果和计算模型（概括，短期获取和长期 维护）将为新的证据提供新的证据，以填补有关当前科学理解的关键空白 失语症治疗方法的有效性和临床应用。更一般地，发现将有助于 为神经系统沟通障碍的临床实践和治疗提供信息；虚拟临床指导 该提案开发的干预措施有可能减少昂贵的临床客户时间 长期康复所必需的。 。