《脑外伤后认知管理的国际共识指南》第三部分：执行功能与自我意识
INCOG recommendations for management of cognition following traumatic brain injury, part III: executive function and self-awareness.
作者信息
Tate Robyn, Kennedy Mary, Ponsford Jennie, Douglas Jacinta, Velikonja Diana, Bayley Mark, Stergiou-Kita Mary
机构信息
Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School-Northern, University of Sydney, Australia (Dr Tate); Royal Rehabilitation Centre Sydney, Australia (Dr Tate); NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Australia (Drs Tate, Ponsford, and Douglas); Department of Communicative Sciences and Disorders, Chapman, University Orange, California, United States (Dr Kennedy); School of Psychology and Psychiatry, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and the Alfred Hospital, Victoria, Australia (Dr Ponsford); School of Human Communication Sciences, La Trobe University, Melbourne, and Summer Foundation, Victoria, Australia (Dr Douglas); Neuropsychology, Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Canada (Dr Velikonja); UHN-Toronto Rehabilitation Institute, and Division of Physiatry, department of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and University of Toronto and Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Stergiou-Kita).
出版信息
J Head Trauma Rehabil. 2014 Jul-Aug;29(4):338-52. doi: 10.1097/HTR.0000000000000068.
INTRODUCTION
Traumatic brain injury (TBI) results in complex cognitive (and other) sequelae. Impairments in executive function and self-awareness are among the most characteristic neuropsychological sequelae and can exert a profound effect on resuming previous life roles. An international group of researchers and clinicians (known as INCOG) convened to develop recommendations for interventions to improve impairments in executive functioning and self-awareness after TBI.
METHODS
The team reviewed the available literature and ensured the recommendations were current. To promote implementation, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate the adherence to the best practice recommendations.
RESULTS
Intervention programs incorporating metacognitive strategy instruction for planning, problem-solving, and other cognitive-executive impairments have a solid evidence base. New evidence supports the use of strategies to specifically improve reasoning skills. Substantial support exists for use of direct corrective feedback to improve self-awareness.
CONCLUSIONS
An increasing number of scientifically well-designed studies are available that demonstrate the effectiveness of a variety of interventions for the remediation of impairments in executive function and self-awareness after TBI.
引言
创伤性脑损伤（TBI）会导致复杂的认知（及其他）后遗症。执行功能和自我意识受损是最具特征性的神经心理学后遗症之一，会对恢复之前的生活角色产生深远影响。一个国际研究人员和临床医生小组（称为INCOG）召开会议，制定改善TBI后执行功能和自我意识受损的干预建议。
方法
该团队回顾了现有文献，并确保这些建议是最新的。为促进实施，该团队根据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。然后，该团队对实施建议进行了优先排序，并制定了审核标准，以评估对最佳实践建议的遵守情况。
结果
纳入元认知策略指导以解决计划、问题解决及其他认知执行功能障碍的干预项目有坚实的证据基础。新证据支持使用特定策略来提高推理能力。大量证据支持使用直接纠正反馈来提高自我意识。
结论
越来越多设计科学合理的研究表明，多种干预措施对改善TBI后执行功能和自我意识受损有效。
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