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理论驱动的治疗调整:讨论如何满足个体失语症患者的语言、认知和心理社会需求。

Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia.

机构信息

Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA.

Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA.

出版信息

J Commun Disord. 2023 May-Jun;103:106327. doi: 10.1016/j.jcomdis.2023.106327. Epub 2023 Apr 14.

Abstract

There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.

摘要

越来越多的文献表明,语言康复可以改善失语症患者的命名障碍。然而,将循证研究应用于临床实践存在挑战。精心控制的临床研究通常由同质样本组成,并排除可能混淆组间结果的个体。因此,研究结果可能无法推广到言语治疗师服务的不同客户。在循证指南内,临床医生可以利用他们的经验和理论基础来调整干预措施,以满足个别客户的需求。然而,对循证干预措施的修改不应改变治疗目标中产生变化所必需的治疗方面。本讨论文件使用失语症命名中的无错误学习、错误学习和检索练习来模拟治疗理论如何指导临床医生对干预措施进行基于理论的修改。首先,我们简要描述了假设支持无错误学习、错误学习和检索练习的学习机制。接下来,我们确定了临床医生可以为优化个别客户学习提供有针对性支持的方法。本文最后反思了定义明确的治疗理论如何促进基于实践的证据的产生和临床相关决策。

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