Overcoming Learned Non-Use in Chronic Aphasia
Status: | Active, not recruiting |
---|---|
Conditions: | Neurology |
Therapuetic Areas: | Neurology |
Healthy: | No |
Age Range: | 21 - 90 |
Updated: | 4/21/2016 |
Start Date: | March 2012 |
End Date: | January 2017 |
Overcoming Learned Non-Use in Chronic Aphasia: Behavioral, fMRI and QoL Outcomes
In this study the investigators are examining the effectiveness of intensive speech therapy
in chronic moderate-to-severe stroke-induced aphasia under two conditions - responses
"constrained" or unconstrained to speech. Both treatments involve massed practice
communicating, using intensive language action therapy 3 hours/day, 5 days/week for two
weeks, followed by six months of a home practice program. One treatment stresses spoken
responses as the preferred expressive modality during intensive therapy. Before and after
treatment, and following the home practice program and a period of no practice, the
investigators will administer several tests and discourse samples to examine changes
associated with the treatments. Participants will also undergo structural and functional MRI
testing at these time points. The investigators will also attempt to quantify the degree to
which improvements following intensive language therapy and home practice correlate with
changes in Quality of Life measures as perceived by both participants with aphasia and their
significant others. It is hypothesized that, whereas both treatments will lead to
improvements in naming practiced words and communicating, outcomes will be enhanced for the
group randomly assigned to the "constraint" condition. Moreover, performance will be
enhanced on words practiced during the home practice program, including those that were not
practiced during intensive therapy. Improved naming will correlate with modulation of
'signature' language and attentional networks, whose variability will depend on remaining
viable brain structures. Initial severity and site/extent of lesion should predict patients'
ability to transfer gains in naming to improvements in discourse.
in chronic moderate-to-severe stroke-induced aphasia under two conditions - responses
"constrained" or unconstrained to speech. Both treatments involve massed practice
communicating, using intensive language action therapy 3 hours/day, 5 days/week for two
weeks, followed by six months of a home practice program. One treatment stresses spoken
responses as the preferred expressive modality during intensive therapy. Before and after
treatment, and following the home practice program and a period of no practice, the
investigators will administer several tests and discourse samples to examine changes
associated with the treatments. Participants will also undergo structural and functional MRI
testing at these time points. The investigators will also attempt to quantify the degree to
which improvements following intensive language therapy and home practice correlate with
changes in Quality of Life measures as perceived by both participants with aphasia and their
significant others. It is hypothesized that, whereas both treatments will lead to
improvements in naming practiced words and communicating, outcomes will be enhanced for the
group randomly assigned to the "constraint" condition. Moreover, performance will be
enhanced on words practiced during the home practice program, including those that were not
practiced during intensive therapy. Improved naming will correlate with modulation of
'signature' language and attentional networks, whose variability will depend on remaining
viable brain structures. Initial severity and site/extent of lesion should predict patients'
ability to transfer gains in naming to improvements in discourse.
Inclusion Criteria:
- unilateral left hemisphere stroke at least 6 months earlier
- aphasia with moderate-to-severe word retrieval impairments
- at least 21 years of age
- premorbidly right handed
- native speaker of English
Exclusion Criteria:
- history of developmental learning difficulties
- history of prior neurological illnesses
- chronic medical illnesses that restrict participation in intensive therapy
- recent alcohol or drug dependence
- severe uncorrected impairments of vision or hearing
- any contraindication to a 3T MRI procedure (e.g., claustrophobia, metal implants or
fragments in body, pregnancy)
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