Linden Mark A, Glang Ann E, McKinlay Audrey
School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK.
Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA.
NeuroRehabilitation. 2018;42(3):311-323. doi: 10.3233/NRE-172357.
Children with brain injuries face significant challenges in their recovery. One of the greatest is transitioning from hospital/home to school where they face issues such as reintegration, lack of understanding and catching up with missed work. Many children struggle with their altered circumstances and require additional supports to meet the academic demands of systems which are ill equipped to teach them.
To summarise the best available evidence for the use of educational interventions to improve academic attainment in childhood survivors of acquired brain injury (ABI).
Six electronic databases (Cinahl, Embase, Medline, PsycINFO, Pubmed, & Web of Science) were systematically searched for randomised controlled trials published between 1980 and 2017. Two authors independently reviewed these studies and extracted data on type of intervention, characteristics of participants, outcome measures, findings and recommendations. The Cochrane Collaboration's Risk of Bias tool was used to assess systematic error in the included studies.
Four studies met the inclusion criteria (n = 296 children and adolescents). Three studies (n = 287) were included in meta-analysis for the primary outcome which showed no statistically significant difference between the intervention and control conditions on academic attainment (SMD 1.31, 95% CI -0.06 to 2.68, p = 0.06). No statistically significant differences were found which favoured the intervention for the secondary outcomes of attention, internalising or externalising behavior. All effect sizes were considered as small.
This review suggests that no currently effective educational interventions exist for children with ABI. Greater efforts are required to produce effective and rigorously tested interventions to improve outcomes for these children.
脑损伤儿童在康复过程中面临重大挑战。其中最大的挑战之一是从医院/家中过渡到学校，在学校他们面临诸如重新融入、缺乏理解以及补上落下的功课等问题。许多儿童在这种改变了的环境中挣扎，需要额外的支持来满足教学体系对他们提出的学术要求，而这些教学体系并没有做好教授他们的准备。
总结关于使用教育干预措施来提高获得性脑损伤（ABI）儿童幸存者学业成绩的现有最佳证据。
系统检索了六个电子数据库（护理学与健康领域数据库、荷兰医学文摘数据库、医学期刊数据库、心理学文摘数据库、美国国立医学图书馆数据库及科学引文索引数据库），以查找1980年至2017年间发表的随机对照试验。两位作者独立审查这些研究，并提取有关干预类型、参与者特征、结果测量、研究结果和建议的数据。使用Cochrane协作网的偏倚风险工具来评估纳入研究中的系统误差。
四项研究符合纳入标准（n = 296名儿童和青少年）。三项研究（n = 287）被纳入主要结局的荟萃分析，结果显示干预组和对照组在学业成绩上无统计学显著差异（标准化均数差1.31，95%可信区间-0.06至2.68，p = 0.06）。在注意力这一次要结局、内化或外化行为方面，未发现有利于干预组的统计学显著差异。所有效应量均被认为较小。
本综述表明，目前不存在对ABI儿童有效的教育干预措施。需要做出更大努力来制定有效且经过严格测试的干预措施，以改善这些儿童的结局。
