Remediating narrative discourse impairments in veterans with TBI: Initial treatment development

修复患有 TBI 的退伍军人的叙事话语障碍：初步治疗开发

基本信息

批准号：
10709570
负责人：
Karen Le
金额：
--
依托单位：
VA CONNECTICUT HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-10-01 至 2026-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10709570
关键词：
Address Affect Afghanistan Aftercare Anxiety Area Behavior Therapy Case Study Chronic Cognition Cognitive Communication Communication impairment Comprehension Computer Assisted Data Development Diagnosis Dimensions Education Educational process of instructing Elements Environment Event Funding Future Goals Growth Headache Home Impairment Incidence Individual Intervention Intervention Studies Iraq Knowledge Language Learning Life Literature Loneliness Manuals Manuscripts Measures Mental Depression Mental Health Methodology Methods Modeling Neurologic Occupational Outcome Participant Partner Communications Peer Review Persons Phase Post-Traumatic Stress Disorders Preparation Process Protocols documentation Quality of life Randomized Randomized, Controlled Trials Reporting Research Research Personnel Sample Size Sampling Secure Severities Social Interaction Social isolation Socialization Stimulus Structure Symptoms Time Training Traumatic Brain Injury Treatment Protocols Veterans Work Writing behavioral clinical trial career comorbidity daily functioning design efficacy evaluation experience feasibility trial follow-up functional improvement improved novel randomized, clinical trials remediation remote delivery satisfaction scaffold service member skill acquisition skills skills training social communication social integration social relationships social skills symposium telehealth telerehabilitation therapy development treatment adherence treatment as usual treatment effect treatment group wound

项目摘要

Cognitive-communication disorders are pervasive following TBI, disrupting communication at the level of discourse (meaningful language beyond sentence level) and social interaction. Discourse impairments impact functioning across major life domains. Research consistently shows that people with discourse impairments following TBI have difficulty securing and maintaining work, struggle with social relationships, experience social isolation, and report a decline in quality of life. Moreover, discourse impairments affect all severity levels of TBI and persist over time. The functional impact and chronicity of discourse impairments following TBI underscore the importance of treating these impairments. The overarching goal of this CDA-2 application is to prepare the candidate for a career in cognitive- communicative interventions research to address discourse impairments in TBI. The aims of the proposed project are to develop and trial a discourse treatment for veterans with TBI. Training goals for the project are to: 1) develop expertise in treatment development, 2) strengthen background in TBI-related comorbidities, 3) expand knowledge of telerehabilitation and computer-aided delivery, 4) develop expertise in conducting randomized clinical trials (RCTs) of behavioral interventions, including statistical and methodological approaches, and 5) further scientific writing, presentation skills, and grantsmanship. Narratives are a fundamental discourse genre embedded in daily conversation. Breakdowns at global levels of narrative discourse are a consistent finding in people with TBI and are apparent at the level of story content and story organization. Impairments in story content include deficiencies in completeness and accuracy of information, global coherence, and summarization. Impairments in story organization include reductions in story grammar elements, sequences of events (episodes) and proportion of the narrative organized by episodes. Discourse intervention in TBI is a nascent area of research, and, to date, there have been only a few studies that have attempted to improve discourse ability in TBI. These prior attempts have been small case studies, produced no change or limited gains, and did not include veterans with TBI. The proposed project is an early stage discourse treatment development study that will evaluate the feasibility of a novel narrative discourse treatment protocol that builds upon these prior attempts with an all-veteran participant sample. The first phase of the study will consist of initial manual development for the discourse treatment protocol and refinement with a small participant sample (5-10 participants). The protocol will incorporate elements from prior treatment studies that showed some promise: 1) hierarchical training, 2) variety of discourse stimuli, 3) development of skills and strategies for discourse processing, 4) structured training prompts, 5) meta-cognitive and meta-linguistic strategies, and 6) integration of learning principles. Novel treatment elements will include: 1) targeting both story content and story organization, 2) use of a discourse model to guide treatment, and 3) functional communication training. Treatment will be delivered twice a week over 8 weeks, with one in-person and one telehealth session each week. There will be four treatment phases: education, story organization, story content, and integration of story organization and content. The second phase will be a treatment feasibility trial on a separate sample of participants to obtain information regarding the tolerability, acceptability, and fidelity of the proposed discourse treatment and preliminary data on treatment delivery and assessment methods as well as preliminary information about treatment effects. Forty participants will be randomized to either the discourse treatment group or Treatment as Usual control. Assessments will be conducted at baseline, post-treatment, and at 1-month follow-up, and will include measures of discourse ability, cognition, mental health, functional communication and daily functioning.

在TBI之后，认知通信障碍无处不在，破坏了在话语（有意义的语言超出句子级别）和社会互动。话语障碍影响跨主要生命领域运作。研究始终表明，有话语障碍的人跟随TBI很难确保和维持工作，与社会关系挣扎，经历社会隔离，报告生活质量下降。此外，话语障碍会影响所有严重程度的TBI 并随着时间的流逝而持续。 TBI后，话语障碍的功能影响和慢性治疗这些障碍的重要性。该CDA-2应用程序的总体目标是为候选人做好认知职业的准备 - 交流干预措施研究以解决TBI的话语障碍。提议的目的项目将开发和试用TBI退伍军人的话语处理。该项目的培训目标是 TO：1）在治疗开发方面发展专业知识，2）加强与TBI相关合并症的背景，3）扩大对居室和计算机辅助交付的知识，4）发展进行专业知识行为干预的随机临床试验（RCT），包括统计和方法论方法和5）进一步的科学写作，演示技巧和授予技巧。叙事是每天对话中嵌入的基本话语类型。全球分解叙事话语的水平在患有TBI的人中是一个一致的发现，并且在故事层面上显而易见内容和故事组织。故事内容的障碍包括完整性和信息的准确性，全球连贯性和摘要。故事组织中的障碍包括故事语法元素的减少，事件序列（情节）和叙事的比例通过情节组织。对TBI的话语干预是一个新生的研究领域，迄今为止，只有少数试图提高TBI话语能力的研究。这些先前的尝试很小研究没有产生任何变化或有限的收益，并且不包括具有TBI的退伍军人。拟议的项目是一项早期阶段的话语治疗发展研究将评估新颖叙述的可行性话语治疗方案基于这些先前尝试的全民参与者样本。研究的第一阶段将包括有关话语治疗方案的初步手动开发并与少量参与者样本（5-10名参与者）进行完善。该协议将合并来自先前的治疗研究表明了一些希望：1）分层训练，2）各种话语刺激，3）讲话处理技能和策略的制定，4）结构化培训提示，5）元认知和元语言策略，以及6）学习原理的整合。新颖的治疗元素将包括： 1）针对故事内容和故事组织，2）使用话语模型指导治疗； 3）功能通信培训。治疗将在8周内每周两次提供，并面对面和每周一次的远程医疗会议。将有四个治疗阶段：教育，故事组织，故事内容以及故事组织和内容的整合。第二阶段将是单独的参与者样本的治疗可行性试验以获得有关拟议的话语待遇的耐受性，可接受性和保真度的信息有关治疗交付和评估方法的初步数据以及有关治疗效果。四十名参与者将被随机分为话语治疗组或治疗通常的控制。评估将在基线，治疗后和1个月的随访中进行，并将包括话语能力，认知，心理健康，功能沟通和日常功能的度量。