Bowen Audrey, Knapp Peter, Gillespie David, Nicolson Donald J, Vail Andy
HCD, School of Psychological Sciences, Ellen Wilkinson Building, University of Manchester, Oxford Road, Manchester, UK, M13 9PL.
Cochrane Database Syst Rev. 2011 Apr 13;2011(4):CD007039. doi: 10.1002/14651858.CD007039.pub2.
Stroke and other adult-acquired brain injury may impair perception leading to distress and increased dependence on others. Perceptual rehabilitation includes functional training, sensory stimulation, strategy training and task repetition.
To examine the evidence for improvement in activities of daily living (ADL) six months post randomisation for active intervention versus placebo or no treatment.
We searched the trials registers of the Cochrane Stroke Group and the Cochrane Infectious Diseases Group (May 2009) but not the Injuries Group, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), CINAHL (1982 to August 2009), PsycINFO (1974 to August 2009), REHABDATA and PsycBITE (May to June 2009). We also searched trials and research registers, handsearched journals, searched reference lists and contacted authors.
Randomised controlled trials of adult stroke or acquired brain injury. Our definition of perception excluded visual field deficits, neglect/inattention and apraxia.
One review author assessed titles, abstracts and keywords for eligibility. At least two review authors independently extracted data. We requested unclear or missing information from corresponding authors.
We included six single-site trials in rehabilitation settings, involving 338 participants. Four trials included people with only stroke. All studies provided sensory stimulation, sometimes with another intervention. Sensory stimulation typically involved practising tasks that required visuo-perceptual processing with occupational therapist assistance. Repetition was never used and only one study included functional training. No trials provided data on longer term improvement in ADL scores. Only three trials provided any data suitable for analysis. Two of these trials compared active to placebo intervention. There was no evidence of a difference in ADL scores at the scheduled end of intervention: mean difference (95% confidence interval (CI)) was 0.9 (-1.6 to 3.5) points on a self-care ADL scale in one study and odds ratio (95% CI) was 1.3 (0.56 to 3.1) for passing a driving test in the other, both in favour of active intervention. The trial that compared two active interventions did not find evidence of difference in any of the review outcomes.
AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the view that perceptual interventions are effective. Future studies should be sufficiently large, include a standard care comparison and measure longer term functional outcomes. People with impaired perception problems should continue to receive neurorehabilitation according to clinical guidelines.
中风及其他成人后天性脑损伤可能损害感知功能，导致患者痛苦并增加对他人的依赖。感知觉康复包括功能训练、感觉刺激、策略训练和任务重复。
研究随机分组后六个月时，积极干预与安慰剂或不治疗相比，在改善日常生活活动（ADL）方面的证据。
我们检索了Cochrane中风小组和Cochrane传染病小组的试验注册库（2009年5月），但未检索损伤小组的注册库、Cochrane对照试验中心注册库（《Cochrane图书馆》2009年第3期）、MEDLINE（1950年至2009年8月）、EMBASE（1980年至2009年8月）、CINAHL（1982年至2009年8月）、PsycINFO（1974年至2009年8月）、REHABDATA和PsycBITE（2009年5月至6月）。我们还检索了试验和研究注册库，手工检索了期刊，检索了参考文献列表并联系了作者。
成人中风或后天性脑损伤的随机对照试验。我们对感知觉的定义排除了视野缺损、忽视/注意力不集中和失用症。
一位综述作者评估标题、摘要和关键词以确定是否符合纳入标准。至少两位综述作者独立提取数据。我们向通讯作者索要不清楚或缺失的信息。
我们纳入了六项康复机构的单中心试验，涉及338名参与者。四项试验仅纳入了中风患者。所有研究均提供感觉刺激，有时还伴有其他干预措施。感觉刺激通常包括在职业治疗师的协助下练习需要视觉感知处理能力的任务。从未使用过重复训练方法，只有一项研究纳入了功能训练。没有试验提供关于ADL评分长期改善的数据。只有三项试验提供了适合分析的数据。其中两项试验比较了积极干预与安慰剂干预。在预定干预结束时没有证据表明ADL评分存在差异：一项研究中，在自我护理ADL量表上，平均差异（95%置信区间（CI））为0.9（-1.6至3.5）分；另一项研究中，通过驾驶考试的优势比（95%CI）为1.3（0.56至3.1），两项结果均支持积极干预。比较两种积极干预措施的试验在任何综述结果中均未发现差异证据。
没有足够的证据支持或反驳感知觉干预有效的观点。未来的研究应该足够大，包括标准护理对照并测量长期功能结局。有感知觉障碍问题的患者应继续根据临床指南接受神经康复治疗。
