主要神经认知障碍(MND)改变认知,记忆和语言,从而影响沟通。言语语言治疗(SLT)可以缓解沟通困难。
这项初步研究探索了强化SLT强调记忆的影响,语言,以及话语障碍和互补的沟通策略,称为交流援助-为与MND生活在一起的人(AID-COMp)。
我们采用了定量和定性方法的混合设计,有四个二元组合,包括与MND(PwMND)生活的人和家庭照顾者。设计包括一个控制期,我们在未治疗前(T1)和2个月后(T2)对参与者进行了测试。然后每周三次密集提供AID-COMp,共10次,参与者再次接受测试(T3)。治疗结束后,参与者还参与了单独的定性访谈,探索他们的经历和可能对他们生活的影响。AID-COMp包括:(1)间隔检索以教授记忆书的使用;(2)用于词汇访问的语义和语音疗法;(3)基于对图片和文本中故事的宏观结构和微观结构的分析的话语处理;(4)PACE疗法进行概括。护理人员不包括在治疗中,没有参加会议,只参与了评估。措施包括语言,通信,认知和幸福测试。配对t检验(单尾)比较了对照期的分数,也就是说,T1与T2。我们比较了治疗后(T3)与T2时的评分。访谈被逐字转录和定性分析。
对于控制周期,PwMND中只有文本理解得分显着下降。治疗后,波士顿命名测试(BNT)的改进,迷你精神状态考试(MMSE)和PwMND的幸福感测量。除了对PwMND交流的感知有所改善外,护工评分在治疗后没有变化。定性发现包括三个主题:(1)了解治疗;(2)恢复能力和关系;(3)命名进一步的需求。
我们假设AID-COMp解决了与MND相关的潜在损害,并为PwMND提供了各种工具来有效地与它们组合。的确,AID-COMp似乎在一定程度上提高了语言技能,认知和情感幸福。这些改进可能会使人们对对话更有信心,并恢复PwMND与其随行人员之间的关系。改进也可能彼此积极作用。这些初步发现保证了对更多参与者的进一步对照研究,包括对参与者体验的定性探索。
关于MND的已知内容会影响认知和交流,这对于照顾者和MND患者之间的良好关系至关重要。仅涉及PwMND的干预措施已被证明是有效的,但不要解决MND轻度阶段的所有沟通障碍。这些干预可能需要多次治疗。一般来说,SLT干预没有检查干预对护理人员的潜在影响。本文对现有知识AID-COMp的补充,为期一个月的10次密集干预,提供给社区中与MND生活的人。它包括训练MND患者使用记忆笔记本结合语义和语音疗法,一种新的话语疗法和PACE疗法,解决几个沟通缺陷。经过2个月的无干预控制期和1个月的强化干预后,结果显示命名有显著改善,认知和沟通,和PwMND福祉。此外,护理人员在与PwMND的日常生活互动中目睹了治疗的影响。这项工作的潜在或实际临床意义是什么AID-COMp可以为PwMND提供通信支持,PwMND和护理人员都报告了进一步的益处。我们详细描述了AID-COMp,以启发临床医生为未送达的PwMND提供SLT。未来的研究应该使用受控设计,更多的参与者和定性的组成部分。
Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties.
This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp).
We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively.
For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND\'s communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs.
We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences.
What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.