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.

TBI 后认知沟通障碍普遍存在，扰乱了沟通水平话语（超越句子层面的有意义的语言）和社交互动。言语障碍影响跨主要生活领域发挥作用。研究一致表明，有言语障碍的人 TBI 后难以确保和维持工作、与社会关系作斗争、缺乏社交体验隔离，并报告生活质量下降。此外，言语障碍影响所有严重程度的 TBI 并随着时间的推移坚持下去。 TBI 后言语障碍的功能影响和长期性强调治疗这些损伤的重要性。此 CDA-2 申请的总体目标是让候选人为认知领域的职业做好准备解决 TBI 中言语障碍的交际干预研究。拟议的目标该项目的目的是为患有 TBI 的退伍军人开发和试验一种言语治疗方法。该项目的培训目标是目的：1) 发展治疗开发方面的专业知识，2) 加强 TBI 相关合并症的背景，3) 扩大远程康复和计算机辅助分娩的知识，4) 发展进行指导的专业知识行为干预的随机临床试验（RCT），包括统计和方法学方法，5) 进一步的科学写作、演讲技巧和资助技巧。叙事是嵌入日常对话中的基本话语体裁。全球细分叙事话语的水平是 TBI 患者的一致发现，并且在故事的水平上很明显内容和故事组织。故事内容的缺陷包括完整性和信息的准确性、整体一致性和总结。故事组织方面的缺陷包括减少故事语法元素、事件顺序（情节）和叙述比例按剧集组织。 TBI 中的话语干预是一个新兴的研究领域，迄今为止，只有少数研究试图提高 TBI 患者言语能力的研究。这些先前的尝试都是小案例研究没有产生任何改变或收益有限，并且不包括患有 TBI 的退伍军人。拟议项目是一项早期话语处理发展研究，将评估小说叙事的可行性话语治疗方案建立在所有退伍军人参与者样本的先前尝试之上。研究的第一阶段将包括话语治疗方案的初步手动开发并通过小规模参与者样本（5-10 名参与者）进行细化。该协议将纳入以下元素：先前的治疗研究显示出一些希望：1）分层训练，2）各种话语刺激，3）发展话语处理的技能和策略，4) 结构化培训提示，5) 元认知和元语言策略，以及6）学习原则的整合。新颖的治疗要素将包括： 1) 针对故事内容和故事组织，2) 使用话语模型来指导治疗，以及 3) 功能性沟通训练。治疗将在 8 周内每周进行两次，其中一次是现场治疗每周一次远程医疗会议。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。第二阶段将是对单独的参与者样本进行治疗可行性试验，以获得有关拟议话语处理的耐受性、可接受性和保真度的信息，以及关于治疗实施和评估方法的初步数据以及关于治疗效果。四十名参与者将被随机分配到话语治疗组或治疗组平时控制。评估将在基线、治疗后和 1 个月随访时进行，并将包括言语能力、认知、心理健康、功能性沟通和日常功能的测量。