针对工作联盟的治疗成分能否改善获得性脑损伤患者的认知康复训练表现？
Do Treatment Ingredients Targeting Working Alliance Improve Cognitive Rehabilitation Session Performance in Patients With Acquired Brain Injury?
作者信息
Rothbart Aaron, Sohlberg McKay Moore, Shune Samantha, Seeley John, Berkman Elliot, Wright Jim
机构信息
Department of Communication Disorders and Sciences, University of Oregon, Eugene.
出版信息
Am J Speech Lang Pathol. 2025 May 6;34(3):1023-1040. doi: 10.1044/2024_AJSLP-24-00347. Epub 2025 Apr 29.
PURPOSE
The purpose of this study was to experimentally evaluate the potential impact of clinician-driven therapy ingredients hypothesized to enhance working alliance (WA) and promote patient engagement during cognitive rehabilitation sessions. It was hypothesized that when the clinician introduced evidence-backed alliance enhancing ingredients, there would be a corresponding improvement in participants' (a) performance on attention drills paired with a metacognitive strategy, (b) learning the steps to use a phone application, and (c) adherence to a home exercise program. It was also hypothesized that patients would show perceptual shifts toward stronger alliance.
METHOD
Four adult participants who sustained moderate to severe acquired brain injuries with chronic cognitive deficits participated in the study. The study used a concurrent multiple-baseline design with randomization. Both visual and quantitative analyses were used to compare potential differences in performance on cognitive rehabilitation tasks when specific alliance enhancing behaviors were integrated into sessions.
RESULTS
Findings showed a strong effect for increased performance on attention span tasks when the clinician added the alliance enhancing treatment ingredients. Participants also learned more steps in the phone application task and either maintained or improved homework adherence in the experimental phase when the treatment ingredients were applied. The findings provided mixed results on participant perceptions of WA, as measured by a modified version of the Working Alliance Inventory.
CONCLUSIONS
This study provides some of the first experimental data demonstrating that alliance enhancing treatment ingredients can have a significant influence on patient performance during cognitive rehabilitation sessions. The article offers recommendations for building on this important line of study.
SUPPLEMENTAL MATERIAL
目的
本研究旨在通过实验评估临床医生主导的治疗要素对认知康复训练中工作联盟（WA）及促进患者参与度的潜在影响。研究假设，当临床医生引入经证据支持的增强联盟要素时，参与者在以下方面会有相应改善：（a）与元认知策略配对的注意力训练任务表现；（b）学习使用手机应用程序的步骤；（c）坚持家庭锻炼计划。此外，研究还假设患者会表现出对更强联盟的认知转变。
方法
四名患有中度至重度后天性脑损伤且伴有慢性认知缺陷的成年参与者参与了本研究。该研究采用了随机化的并发多基线设计。在将特定的增强联盟行为纳入训练课程时，运用视觉分析和定量分析来比较认知康复任务表现的潜在差异。
结果
研究结果显示，当临床医生添加增强联盟的治疗要素时，参与者在注意力跨度任务上的表现有显著提升。在应用治疗要素的实验阶段，参与者在手机应用程序任务中也学到了更多步骤，并且家庭作业的坚持度保持稳定或有所提高。通过工作联盟量表的修改版衡量，研究结果在参与者对工作联盟的认知方面呈现出复杂的结果。
结论
本研究提供了一些初步实验数据，证明增强联盟的治疗要素在认知康复训练期间可对患者表现产生重大影响。本文为推进这一重要研究方向提供了建议。
Zotero 插件