Klonoff Pamela S, Olson Karen C, Talley Melanie C, Husk Kristi L, Myles Stephen M, Gehrels Jo-Ann, Dawson Lauren K
Catholic Healthcare West, Barrow Neurological Institute, Center for Transitional NeuroRehabilitation, Phoenix, AZ 85013, USA.
Brain Inj. 2010 Feb;24(2):63-73. doi: 10.3109/02699050903512863.
To explore the relationship of cognitive retraining performance to discharge driving status.
One hundred and three brain-injured patients from a holistic milieu-oriented work/school re-entry programme.
Initial, last, mean, and best cognitive retraining scores; Behavioural Checklist ratings; Working Alliance (WA) scores.
At the time of discharge, 50.5% of the sample were cleared to drive. Better performance on a cognitive retraining task addressing information processing and motor speed, focused attention, visual scanning and memory was associated with clearance to drive. Patients' behavioural approach to cognitive retraining tasks (use of compensations, organizational and procedural skills) and higher mean and discharge WA scores with staff were associated with driving clearance. Higher mean WA scores were also related to an enhanced behavioural approach to cognitive retraining tasks, including timeliness to sessions, compensation use, better communication pragmatics, decreased distractibility and the ability to apply the 'big picture' benefits of cognitive retraining to the 'real world'.
Cognitive retraining exercises that incorporate skill remediation, 'process' variables and metacognitive skills, as well as a better WA with patients, positively related to clearance to drive at the time of discharge from a holistic milieu-oriented programme.
探究认知再训练表现与出院时驾驶状态之间的关系。
从一个以整体环境为导向的工作/学校重新融入计划中选取103名脑损伤患者。
初始、末次、平均及最佳认知再训练得分；行为清单评分；工作联盟（WA）得分。
出院时，50.5%的样本被批准可以驾驶。在一项涉及信息处理、运动速度、集中注意力、视觉扫描和记忆的认知再训练任务中表现更好与被批准驾驶相关。患者在认知再训练任务中的行为方式（使用补偿策略、组织和程序技能）以及与工作人员的平均WA得分和出院WA得分较高与驾驶批准相关。较高的平均WA得分还与对认知再训练任务增强的行为方式有关，包括按时参加训练、使用补偿策略、更好的沟通语用学、注意力分散减少以及将认知再训练的“全局”益处应用于“现实世界”的能力。
在一个以整体环境为导向的计划中，结合技能补救、“过程”变量和元认知技能的认知再训练练习，以及与患者更好的工作联盟，与出院时被批准驾驶呈正相关。
