PDF(Pubmed)
Abstract：
BACKGROUND: Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]).
OBJECTIVE: This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia.
METHODS: We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants\' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists\' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period.
RESULTS: Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences.
CONCLUSIONS: The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual\'s specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences.
BACKGROUND: ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818.
OBJECTIVE: This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia.
METHODS: We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants\' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists\' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period.
RESULTS: Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences.
CONCLUSIONS: The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual\'s specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences.
BACKGROUND: ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818.
摘要：
背景：失语症是一种沟通障碍，影响超过三分之一的卒中幸存者。计算机语音和语言治疗（CSLT）是一个复杂的干预需要计算机软件，言语和语言治疗师，志愿者,或者治疗助理,以及失语症患者的自我管理实践。CSLT被发现可以改善单词查找，失语症的常见症状,一项多中心随机对照试验（卒中后失语症的计算机治疗[BigCACTUS]的临床和成本效益）。
目的：这项研究提供了在BigCACTUS试验中提供的CSLT干预措施的详细描述，并确定了干预措施的活性成分与改善失语症患者的单词发现直接相关。
方法：我们在一项随机对照试验的背景下进行了一项多方法研究。在研究1中，定性访谈探讨了关键线人对CSLT干预的理解，组件是如何相互作用的，以及如何测量它们。定性数据逐字转录并进行主题分析。定性结果告知了在BigCACTUS试验中作为CSLT干预措施过程评估的一部分收集的过程措施。在研究2中，定量分析探讨了干预过程措施之间的关系（计算机治疗访问时间；治疗师对CSLT的知识；CSLT剪裁的理论基础程度；以及使用该软件练习提示对抗命名所花费的时间，非提示命名，并在功能句子中使用单词），并在6个月的干预期内改变单词发现能力。
结果：对7名CSLT方法专家进行了定性访谈。主题分析确定了CSLT方法的四个总体组成部分：（1）StepByStep软件（第5版；StepsConsultingLtd），（2）治疗设置：剪裁和个性化，（3）定期独立执业，(4)支持和监测。定量分析包括来自83名随机分配到BigCACTUS试验干预组的参与者的过程和结果数据。被发现与提高单词发现能力直接相关的过程措施是，治疗师为定制计算机化治疗练习以及失语症患者使用计算机软件练习在功能句子中使用单词所花费的时间提供了全面的依据。
结论：对CSLT方法的定性探索提供了对组件的详细描述，理论,和支持干预的机制，并有助于确定在BigCACTUS试验中收集的过程措施。定量分析进一步加深了我们对干预措施的哪些组成部分与临床改善相关的理解。为了优化使用CSLT方法进行单词查找的好处，建议治疗师特别注意干预措施的活性成分：根据个人的特定语言障碍定制治疗练习，并鼓励失语症患者练习专注于在功能句子中说出单词的练习。
背景：ISRCTN注册表ISRCTN68798818;https://www。isrctn.com/ISRCTN68798818.
目的：这项研究提供了在BigCACTUS试验中提供的CSLT干预措施的详细描述，并确定了干预措施的活性成分与改善失语症患者的单词发现直接相关。
方法：我们在一项随机对照试验的背景下进行了一项多方法研究。在研究1中，定性访谈探讨了关键线人对CSLT干预的理解，组件是如何相互作用的，以及如何测量它们。定性数据逐字转录并进行主题分析。定性结果告知了在BigCACTUS试验中作为CSLT干预措施过程评估的一部分收集的过程措施。在研究2中，定量分析探讨了干预过程措施之间的关系（计算机治疗访问时间；治疗师对CSLT的知识；CSLT剪裁的理论基础程度；以及使用该软件练习提示对抗命名所花费的时间，非提示命名，并在功能句子中使用单词），并在6个月的干预期内改变单词发现能力。
结果：对7名CSLT方法专家进行了定性访谈。主题分析确定了CSLT方法的四个总体组成部分：（1）StepByStep软件（第5版；StepsConsultingLtd），（2）治疗设置：剪裁和个性化，（3）定期独立执业，(4)支持和监测。定量分析包括来自83名随机分配到BigCACTUS试验干预组的参与者的过程和结果数据。被发现与提高单词发现能力直接相关的过程措施是，治疗师为定制计算机化治疗练习以及失语症患者使用计算机软件练习在功能句子中使用单词所花费的时间提供了全面的依据。
结论：对CSLT方法的定性探索提供了对组件的详细描述，理论,和支持干预的机制，并有助于确定在BigCACTUS试验中收集的过程措施。定量分析进一步加深了我们对干预措施的哪些组成部分与临床改善相关的理解。为了优化使用CSLT方法进行单词查找的好处，建议治疗师特别注意干预措施的活性成分：根据个人的特定语言障碍定制治疗练习，并鼓励失语症患者练习专注于在功能句子中说出单词的练习。
背景：ISRCTN注册表ISRCTN68798818;https://www。isrctn.com/ISRCTN68798818.
