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）：尽管最近的证据表明治疗诱导慢性失语症的神经可塑性，但关于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、相关的生活质量改善的证据仍然存在疑问。生活质量）。拟议研究的长期目标是更好地了解治疗变量如何影响慢性失语症的恢复，包括支持改进命名的大脑/行为机制，以及这些改进如何影响生活质量。目前的目标是：首先，确定针对中度至重度表达性失语症患者的找词障碍的强化治疗是否有效，无论言语练习如何；其次，确定治疗引起的命名改善的特征神经模式；第三，描述受影响家庭中语言能力提高与生活质量之间的关系。目前的研究提出了失语症康复的纵向病例系列方法，重点关注一个变量（隐性治疗与显性治疗）对慢性中重度患者语言、神经生理和心理社会变化的影响。这三个具体目标是： 1) 确定约束诱导语言治疗 (CILT) 后命名方面的收益是否超过非约束语言治疗 (ULT) 后观察到的收益、超过失语症的类型和严重程度，以及是否可以维持收益随着时间的推移。中心假设是，参与者，即使是那些患有持续性严重不流利失语症和共病言语失用症的参与者，也将从这两种强化治疗计划中受益，其中随机分配到 CILT 的参与者有显着的获益。在 CILT 和 ULT 之后训练和练习（即“过度学习”）的单词将在 12 个月的后续测试中表现出更好的维护能力； 2) 表征与改进的图片命名相关的 fMRI 激活模式。工作假设是，改进的命名与根据病变部位/范围而变化的备用网络的调制相关； 3) 量化短期强化语言治疗后的改善与失语症参与者及其重要他人所感知的生活质量指标变化的相关程度。初步数据表明，改进的命名可以“启动”陷入习得性不使用的语言系统，并刺激已知与生活质量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，首先是因为采用了三管齐下（行为、神经影像、生活质量）纵向病例系列方法，并且有可能证明短期强化治疗加上维持家庭治疗计划所带来的有意义的长期变化，其次是因为，因为它在一定程度上关注的是比通常研究的受影响更严重的人群。这一贡献意义重大，因为提高我们对真正的解剖学、功能和行为限制以及中风后语言恢复潜力的了解可能会影响对慢性失语症患者提供服务的看法。