Transferring Speed of Processing Gains to Everyday Cognitive Tasks after Stroke

将中风后处理速度的提高转移到日常认知任务中

• 批准号: 10908025
• 负责人: KARLENE K BALL
• 金额: $ 16.21万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-05 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10908025
• 关键词: Address; Adult; Affect; Aftercare; Automobile Driving; Basic Science; Behavioral; Caregivers; Caring; Cognition; Cognitive; Cognitive deficits; Communities; Data; Dementia; Disease; Elderly; Evaluation; Exhibits; Family member; Impaired cognition; Impairment; Individual; Intervention; Laboratories; Life; Measurement; Measures; Methods; Modeling; Motor; Movement; Outcome; Participant; Patient Care; Patients; Performance; Persons; Prevalence; Procedures; Process; Quality of life; Randomized, Controlled Trials; Rehabilitation therapy; Research; Research Personnel; Research Proposals; Sample Size; Sampling; Savings; Signal Transduction; Site; Speed; Stroke; Task Performances; Techniques; Testing; Training; Work; arm; blood oxygenation level dependent response; care costs; caregiving; chronic stroke; cognitive ability; cognitive function; cognitive rehabilitation; cognitive task; cost; design; experience; follow-up; functional improvement; improved; information processing; instrumental activity of daily living; new combination therapies; novel; post stroke; post stroke cognitive impairment; processing speed; stroke patient; therapy design; treatment effect

ABSTRACT Many individuals with cognitive impairment experience decrements in everyday function that can signal encroaching dementia. For every year that cognitive decline is delayed there is substantial savings in patient care costs and inestimable savings in quality of life for patients and family members. The prevalence of cognitive impairment in chronic stroke is approximately 50%. A number of techniques have been found to improve various aspects of cognition in the training situation. However, their transfer to everyday situations outside the training setting has been limited as is retention. They are therefore of reduced or narrow practical value. A cognitive ability that is improved but not used to enhance real-world performance has limited significance. Pilot work has been carried out here with a novel intervention designed to fill these crucial gaps. The results are very promising. The purpose of the proposed research is to carry out a randomized controlled trial (RCT) with a large enough sample to rigorously evaluate these preliminary results. The new treatment to be tested combines two repeatedly validated rehabilitation methods: the Transfer Package of CI Movement Therapy and Speed of Cognitive Processing Training. The purpose of doing so is to produce a marked enhancement in the transfer of cognitive improvement from the training setting to instrumental activities of daily living (IADL) in everyday situations. Both halves of the new combination therapy are founded on the investigators' own basic research. In both cases, efficacy is supported by positive results from multiple single-site RCTs and a large multisite RCT. However, the effect of Speed of Processing Training has been found to have limited generalization to cognitive-based IADL in everyday situations. In contrast, one of the main strengths of CI Therapy is that it produces a robust and extensive transfer of treatment effect to everyday life situations by means, in part, of its Transfer Package. A second strength of the Transfer Package of CI Therapy is long-term retention of its effect. In our initial work, the Transfer Package procedures that this lab has used effectively to transfer motor gains from the treatment to everyday setting were adapted to transfer cognitive gains from the treatment to the everyday setting. We propose here an RCT with 2 arms: Speed of Processing Training (SOPT) in the lab combined with the TP (TP+) and SOPT in the lab but without the TP (TP-). Participants will be 120 adults more than 1-year post-stroke with mild to moderate cognitive impairment. Performance on cognitive-based tasks will be measured in daily life and in the lab before and after baseline, after treatment, and 6- and 12-months afterwards. This design will permit rigorous testing of the value of the Transfer Package with an adequate sample size, objective measurement, blinding, and between-subjects control for amount and intensity of training and therapist contact.

抽象的 许多具有认知障碍经验的人的日常功能降低，可以发出信号 侵占痴呆症。每年认知下降被推迟，患者节省了可观的节省 护理成本和不可估量的患者和家人的生活质量。流行率 慢性中风的认知障碍约为50％。已经发现了许多技术 在培训情况下改善认知的各个方面。但是，它们转移到日常情况 在培训环境之外，保留率也受到限制。因此，它们的实用性减少或狭窄 价值。改进但不用于增强现实世界表现的认知能力有限 意义。在这里进行了试点工作，并进行了一种新颖的干预措施，旨在填补这些关键的空白。 结果非常有前途。拟议研究的目的是进行随机控制 试验（RCT）具有足够大的样本，可以严格评估这些初步结果。 要测试的新方法结合了两种反复验证的康复方法：转移 CI运动疗法的包装和认知处理训练的速度。这样做的目的是 在从训练环境中转移到认知的改善方面产生明显的增强 日常情况下日常生活的乐器活动。新组合疗法的两半 建立在调查人员自己的基础研究上。在这两种情况下，疗效都得到积极结果的支持 来自多个单位RCT和大型多站点RCT。但是，加工训练速度的影响 在日常情况下，人们发现对基于认知的IADL的概括有限。相反，一个 CI疗法的主要优势是，它产生了强大而广泛的治疗效果转移到 日常生活的情况部分是通过其转移包的。转移套餐的第二强度 CI疗法的长期保留效果。在我们最初的工作中，转移包程序 实验室已有效地将运动收益从治疗转移到日常设置。 认知能力从治疗到日常环境。 我们在这里提出了一个带2个臂的RCT：实验室中的处理速度训练速度（SOPT）与 实验室中的TP（TP+）和SOPT，但没有TP（TP-）。参与者将超过1年成年人 中风后轻度至中度认知障碍。基于认知的任务的表现将是 在日常生活中和基线前后的实验室中测量，治疗后以及6个月和12个月 然后。该设计将允许对转移套件的价值进行严格测试，并有足够的 样本量，客观测量，盲目和受试者之间控制量和强度 培训和治疗师联系。