Chung Charlie S Y, Pollock Alex, Campbell Tanya, Durward Brian R, Hagen Suzanne
Department of Occupational Therapy, NHS Fife, Kirkcaldy, UK.
Cochrane Database Syst Rev. 2013 Apr 30;2013(4):CD008391. doi: 10.1002/14651858.CD008391.pub2.
Executive functions are the controlling mechanisms of the brain and include the processes of planning, initiation, organisation, inhibition, problem solving, self monitoring and error correction. They are essential for goal-oriented behaviour and responding to new and novel situations. A high number of people with acquired brain injury, including around 75% of stroke survivors, will experience executive dysfunction. Executive dysfunction reduces capacity to regain independence in activities of daily living (ADL), particularly when alternative movement strategies are necessary to compensate for limb weakness. Improving executive function may lead to increased independence with ADL. There are various cognitive rehabilitation strategies for training executive function used within clinical practice and it is necessary to determine the effectiveness of these interventions.
To determine the effects of cognitive rehabilitation on executive dysfunction for adults with stroke or other non-progressive acquired brain injuries.
We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, August 2012), MEDLINE (1950 to August 2012), EMBASE (1980 to August 2012), CINAHL (1982 to August 2012), PsycINFO (1806 to August 2012), AMED (1985 to August 2012) and 11 additional databases. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts.
We included randomised trials in adults after non-progressive acquired brain injury, where the intervention was specifically targeted at improving cognition including separable executive function data (restorative interventions), where the intervention was aimed at training participants in methods to compensate for lost executive function (compensative interventions) or where the intervention involved the training in the use of an adaptive technique for improving independence with ADL (adaptive interventions). The primary outcome was global executive function and the secondary outcomes were specific components of executive function, working memory, ADL, extended ADL, quality of life and participation in vocational activities. We included studies in which the comparison intervention was no treatment, a placebo intervention (i.e. a rehabilitation intervention that should not impact on executive function), standard care or another cognitive rehabilitation intervention.
Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data and other potential sources of bias.
Nineteen studies (907 participants) met the inclusion criteria for this review. We included 13 studies (770 participants) in meta-analyses (417 traumatic brain injury, 304 stroke, 49 other acquired brain injury) reducing to 660 participants once non-included intervention groups were removed from three and four group studies. We were unable to obtain data from the remaining six studies. Three studies (134 participants) compared cognitive rehabilitation with sensorimotor therapy. None reported our primary outcome; data from one study was available relating to secondary outcomes including concept formation and ADL. Six studies (333 participants) compared cognitive rehabilitation with no treatment or placebo. None reported our primary outcome; data from four studies demonstrated no statistically significant effect of cognitive rehabilitation on secondary outcomes. Ten studies (448 participants) compared two different cognitive rehabilitation approaches. Two studies (82 participants) reported the primary outcome; no statistically significant effect was found. Data from eight studies demonstrated no statistically significant effect on the secondary outcomes. We explored the effect of restorative interventions (10 studies, 468 participants) and compensative interventions (four studies, 128 participants) and found no statistically significant effect compared with other interventions.
AUTHORS' CONCLUSIONS: We identified insufficient high-quality evidence to reach any generalised conclusions about the effect of cognitive rehabilitation on executive function, or other secondary outcome measures. Further high-quality research comparing cognitive rehabilitation with no intervention, placebo or sensorimotor interventions is recommended.
执行功能是大脑的控制机制，包括计划、启动、组织、抑制、解决问题、自我监测和纠错等过程。它们对于目标导向行为以及应对新的和新颖的情况至关重要。大量获得性脑损伤患者，包括约75%的中风幸存者，会出现执行功能障碍。执行功能障碍会降低在日常生活活动（ADL）中重新获得独立的能力，尤其是当需要替代运动策略来补偿肢体无力时。改善执行功能可能会提高ADL的独立性。临床实践中使用了各种认知康复策略来训练执行功能，确定这些干预措施的有效性很有必要。
确定认知康复对中风或其他非进行性获得性脑损伤成人执行功能障碍的影响。
我们检索了Cochrane中风小组试验注册库（2012年8月）、Cochrane对照试验中央注册库（Cochrane图书馆，2012年8月）、MEDLINE（1950年至2012年8月）、EMBASE（1980年至2012年8月）、CINAHL（1982年至2012年8月）、PsycINFO（1806年至2012年8月）、AMED（1985年至2012年8月）以及另外11个数据库。我们还检索了参考文献列表和试验注册库，手工检索了期刊和会议论文集，并联系了专家。
我们纳入了非进行性获得性脑损伤后成人的随机试验。干预措施专门针对改善认知，包括可分离的执行功能数据（恢复性干预）；干预措施旨在训练参与者补偿执行功能丧失的方法（补偿性干预）；或者干预措施涉及训练使用适应性技术以提高ADL的独立性（适应性干预）。主要结局是整体执行功能，次要结局是执行功能的特定组成部分、工作记忆、ADL、扩展ADL、生活质量和职业活动参与度。我们纳入了比较干预措施为无治疗、安慰剂干预（即不应影响执行功能的康复干预）、标准护理或另一种认知康复干预的研究。
两位综述作者独立筛选摘要、提取数据并评估试验。我们对分配隐藏、结局评估者的盲法、处理缺失数据的方法以及其他潜在偏倚来源进行了方法学质量评估。
19项研究（907名参与者）符合本综述的纳入标准。我们将13项研究（770名参与者）纳入荟萃分析（417例创伤性脑损伤、304例中风、49例其他获得性脑损伤），一旦从三项和四项研究的非纳入干预组中剔除，参与者人数减至660名。我们无法从其余六项研究中获取数据。三项研究（134名参与者）将认知康复与感觉运动疗法进行了比较。均未报告我们的主要结局；有一项研究的数据与次要结局相关，包括概念形成和ADL。六项研究（3
