Malá Hana, Rasmussen Camilla Pihl
Restor Neurol Neurosci. 2017;35(1):25-64. doi: 10.3233/RNN-160682.
Acquired brain injuries (ABI) have devastating effects for the affected individual as well as society. Many studies have investigated the effect of different monotherapies. However, functional recovery is typically only partial. One possible strategy to promote a greater degree of recovery is to apply monotherapies in combination with one or more treatments.
The objective of this systematic review is to investigate if approaches combining enriched environment (EE), exercise, or task-specific training with other monotherapies, further enhance the degree of recovery after ABI.
Scopus, PsychINFO, and PubMed databases were searched in March 2016 with the following search strings: exercise (or) enriched environment (or) environmental enrichment (or) rehabilitation (and) traumatic brain injury (or) ischemia (or) stroke (and) rat (or) rodent. Studies were included if they (1) were in English, (2) used adult animals subjected to brain injury, (3) included EE, and/or exercise, and/or task-specific training as post-injury treatment strategies, (4) included at least one group receiving another monotherapy. Out of 2.168 hits, 29 studies fulfilled the inclusion criteria.
Despite several trends for enhanced recovery after combined therapies, this systematic review of 29 studies does not indicate that combined therapies confer consistent combined effects on motor, cognitive, or cerebral recovery according to present criteria for combined effect.
Combined treatments continue to provide hope for enhanced recovery after ABI, however, the research area is in its infancy. This systematic review does not provide conclusive evidence. This is likely due to sparse knowledge regarding optimal treatment parameters. Combined treatments, however, hold the best promise regarding treatment of the complex changes induced by ABI.
获得性脑损伤（ABI）对受影响的个体以及社会都具有毁灭性影响。许多研究调查了不同单一疗法的效果。然而，功能恢复通常只是部分性的。促进更大程度恢复的一种可能策略是将单一疗法与一种或多种其他治疗方法联合应用。
本系统评价的目的是研究将丰富环境（EE）、运动或特定任务训练与其他单一疗法相结合的方法是否能进一步提高ABI后的恢复程度。
2016年3月在Scopus、PsychINFO和PubMed数据库中进行检索，检索词如下：运动（或）丰富环境（或）环境富集（或）康复（和）创伤性脑损伤（或）缺血（或）中风（和）大鼠（或）啮齿动物。纳入的研究需满足以下条件：（1）英文发表；（2）使用成年脑损伤动物；（3）将EE和/或运动和/或特定任务训练作为损伤后治疗策略；（4）至少有一组接受另一种单一疗法。在检索到的2168条结果中，29项研究符合纳入标准。
尽管联合疗法后有几种增强恢复的趋势，但根据目前联合效应的标准，对这29项研究进行的系统评价并未表明联合疗法对运动、认知或脑恢复具有一致的联合效应。
联合治疗仍然为ABI后增强恢复带来希望，然而，该研究领域尚处于起步阶段。本系统评价未提供确凿证据。这可能是由于关于最佳治疗参数的知识匮乏。然而，联合治疗对于治疗ABI引起的复杂变化最有前景。
