Schweizer Tom A, Levine Brian, Rewilak Dmytro, O'Connor Charlene, Turner Gary, Alexander Michael P, Cusimano Michael, Manly Tom, Robertson Ian H, Stuss Donald T
Rotman Research Institute, Baycrest, Toronto, ON, Canada.
Neurorehabil Neural Repair. 2008 Jan-Feb;22(1):72-7. doi: 10.1177/1545968307305303. Epub 2007 Jul 30.
Executive dysfunction accounts for significant disability in patients with many types of brain injury in many locations. Clinical reports have described impaired executive functioning after damage to the cerebellum, and anatomical and neuroimaging studies have identified the likely basis for this effect: a cortico-ponto-cerebellar network through which the cerebellum is densely connected to areas of frontal cortex. The patterns of executive impairment attributable to cerebellar damage have been extensively described in the past 15 years, but there has been no assessment of the efficacy of rehabilitation in this patient population. Here, the use of a cognitive rehabilitation technique, Goal Management Training, in a patient with persisting executive dysfunction after a right cerebellar hemorrhage is described. The patient made and maintained modest gains on measures of sustained attention, planning, and organization that translated into significant improvement in real-life functioning. This is the first report on the rehabilitation of impaired executive functioning following focal damage to the cerebellum and in the presence of intact frontal cortex.
执行功能障碍在许多部位发生多种类型脑损伤的患者中导致了严重的残疾。临床报告描述了小脑损伤后执行功能受损的情况，解剖学和神经影像学研究已经确定了这种影响的可能基础：一个皮质-脑桥-小脑网络，通过该网络小脑与额叶皮质区域紧密相连。在过去15年中，已经广泛描述了小脑损伤所致执行功能障碍的模式，但尚未对该患者群体的康复效果进行评估。在此，描述了对一名右侧小脑出血后持续存在执行功能障碍的患者使用认知康复技术——目标管理训练的情况。该患者在持续注意力、计划和组织能力的测量方面取得并维持了适度的进步，这些进步转化为现实生活功能的显著改善。这是关于小脑局灶性损伤且额叶皮质完整的情况下执行功能受损康复的首例报告。
