《创伤性脑损伤后认知管理的INCOG建议，第二部分：注意力与信息处理速度》
INCOG recommendations for management of cognition following traumatic brain injury, part II: attention and information processing speed.
作者信息
Ponsford Jennie, Bayley Mark, Wiseman-Hakes Catherine, Togher Leanne, Velikonja Diana, McIntyre Amanda, Janzen Shannon, Tate Robyn
机构信息
NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Canberra, Australia (Drs Ponsford, Togher, and Tate); School of Psychological Sciences, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and the Alfred Hospital, Melbourne, Australia (Dr Ponsford); Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada (Dr Bayley); Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada (Dr Wiseman-Hakes); Speech Pathology, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia (Dr Togher); Neuropsychology, Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Ms Velikonja); Lawson Health Research Institute, London, Canada (Mss McIntyre and Janzen); Royal Rehabilitation Centre Sydney, New South Wales, Australia (Dr Tate); and Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School-Northern, University of Sydney, Australia (Dr Tate).
出版信息
J Head Trauma Rehabil. 2014 Jul-Aug;29(4):321-37. doi: 10.1097/HTR.0000000000000072.
INTRODUCTION
Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems.
METHODS
The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to these best practices.
RESULTS
The recommendations and discussion highlight that metacognitive strategy training focused on functional everyday activities is appropriate. Appropriate use of dual task training, environmental modifications, and cognitive behavioral therapy is also discussed. There is insufficient evidence to support mindfulness meditation and practice on de-contextualized computer-based tasks for attention. Administration of the medication methylphenidate should be considered to improve information-processing speed.
CONCLUSION
The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury.
引言
创伤性脑损伤因其具有弥漫性，且额颞叶和中脑网状激活系统受伤频率较高，可能会在注意力的多个方面造成干扰：觉醒、选择性注意、信息处理速度以及注意力的策略控制，包括持续注意、注意力的转移和分配以及工作记忆。一个由研究人员和临床医生组成的国际团队（称为INCOG）召开会议，以制定针对注意力问题管理的建议。
方法
专家们从已发表的指南中选取建议，然后查阅文献以确保这些建议是最新的。基于已发表试验的纳入和排除标准，制定了纳入这些建议的决策算法。该团队随后对实施建议进行了优先级排序，并制定了审核标准以评估对这些最佳实践的遵守情况。
结果
这些建议和讨论强调，专注于功能性日常活动的元认知策略训练是合适的。还讨论了双重任务训练、环境调整和认知行为疗法的适当使用。没有足够的证据支持正念冥想以及针对注意力的脱离情境的基于计算机任务的练习。应考虑使用药物哌甲酯来提高信息处理速度。
结论
INCOG关于注意力康复的建议为治疗创伤性脑损伤患者的临床医生提供了最新指导。
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