■人类专家表演领域告诉我们,高质量,大剂量指导实践需要在认知驱动的行为中取得巨大收益。对于获得性脑损伤的人来说似乎也是如此,然而,针对失语症患者(PWA)的治疗服务传统上并未考虑到这一点.强化综合失语症计划(ICAP)是解决大多数PWA经历的长期治疗剂量不足的一种方法。
■有几种方法可以交付ICAP;在这里,我们描述了我们的QueenSquareICAP的两次迭代。在第1年(Y1)和第2年(Y2)ICAP组之间有20个月的COVID诱导的停顿。我们分析了ICAP引起的两组PWA的一系列关键结果指标的变化,这些指标涵盖了国际功能分类,残疾与健康,涵盖语言障碍和功能以及情绪和社会参与。
■46个PWA参加了Y1,44个参加了Y2。PWA均处于卒中后慢性期,失语症严重程度从轻度到重度不等,Y2组比Y1组受损更多。在ICAP之前和之后收集定量数据。Y2治疗团队对他们提供ICAP的经验进行了独立思考。
■与ICAP相关的结果测量变化(减值,功能和目标达成)在Y1和Y2组中通常具有可比性,两组的语音表达能力都得到了最大的提高。两组在主要生活质量指标上都取得了临床和统计学上的显着进步。参加ICAP对PWA的自信心评分产生了很大的影响。他们的情绪评分也显著提高,虽然他们不是,平均而言,在基线的抑郁范围内(直接在ICAP之前)。在3个月的随访中,两组取得的所有改善均保持不变。强调ICAP可以提供的持久影响。
■继续有证据表明,ICAP是增加慢性失语症患者所需的专家指导剂量的有效方法,以在临床上有意义地改善其沟通能力和生活质量。剩下的主要挑战是说服医疗保健提供者对其进行投资。
UNASSIGNED: The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience.
UNASSIGNED: There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square
ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2)
ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation.
UNASSIGNED: Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the
ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an
ICAP.
UNASSIGNED: ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups\' speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the
ICAP made a big difference to PWAs\' self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide.
UNASSIGNED: Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.