《脑外伤后认知管理的INCOG建议，第四部分：认知交流》
INCOG recommendations for management of cognition following traumatic brain injury, part IV: cognitive communication.
作者信息
Togher Leanne, Wiseman-Hakes Catherine, Douglas Jacinta, Stergiou-Kita Mary, Ponsford Jennie, Teasell Robert, Bayley Mark, Turkstra Lyn S
机构信息
Speech Pathology, Faculty of Health Sciences, The University of Sydney, Australia (Dr Togher); NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Australia (Drs Togher and Ponsford and Ms Douglas); Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada (Dr Wiseman-Hakes); Department of Human Communication Sciences, La Trobe University, Victoria, Australia (Ms Douglas); Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada (Dr Stergiou-Kita); School of Psychology and Psychiatry, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and The Alfred Hospital (Dr Ponsford); Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada (Dr Teasell); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada (Dr Teasell); UHN-Toronto Rehabilitation Institute and Division of Physical Medicine and Rehabilitation University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and Department of Communication Sciences and Disorders, University of Wisconsin-Madison (Dr Turkstra).
出版信息
J Head Trauma Rehabil. 2014 Jul-Aug;29(4):353-68. doi: 10.1097/HTR.0000000000000071.
INTRODUCTION
Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention.
METHODS
An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations.
RESULTS
Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the person's needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format.
CONCLUSION
There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.
引言
认知交流障碍在创伤性脑损伤（TBI）患者中很常见，并且会对长期预后产生重大影响。因此需要基于证据的康复指南，于是一个国际研究人员和临床医生小组（称为INCOG）召开会议，制定评估和干预建议。
方法
一个专家小组开会，根据现有文献为认知交流障碍的评估和治疗选择合适的建议。为促进实施，该团队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，然后对实施建议进行优先排序，并制定审核标准以评估对最佳实践建议的遵守情况。
结果
认知交流障碍患者的康复应考虑病前交流状态；根据个人需求、目标和技能进行个性化定制；在适当情况下提供辅助技术使用培训；包括对交流伙伴的培训；并在具体情境中进行，以尽量减少泛化的需求。有证据支持以小组形式治疗社交交流问题。
结论
有充分证据支持以患者为中心治疗认知交流障碍，并使用诸如无错误学习、元认知策略训练和小组治疗等教学策略。未来的研究应包括对替代服务提供模式的测试以及参与水平结果测量的开发。
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