Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea.
Yonsei University College of Medicine, Seoul, South Korea.
Eur J Phys Rehabil Med. 2021 Aug;57(4):551-559. doi: 10.23736/S1973-9087.21.06497-2. Epub 2021 Jan 15.
Cognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapist-driven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR.
To investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI.
A prospective, assessor-blinded randomized controlled trial.
Hospitalized care setting in the department of rehabilitation in a university hospital.
Thirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days.
Participants were assigned to the TCR group (N.=14) or the CCR group (N.=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination [MMSE] and Montreal Cognitive Assessment [MoCA]), and functional evaluations [modified Barthel Index, MBI]) were performed at baseline (T0) and at the end of treatment (T1).
The TCR and CCR groups showed significant improvements in the MMSE (P=0.004, 0.000), MoCA (P=0.003, 0.006), and MBI (P=0.000, 0.000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, P=0.002, 0.005) and executive function tests (trail-making test B, P=0.016, 0.016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, P=0.004, semantic fluency test, P=0.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, P=0.02, digit symbol coding, P=0.002). In the intergroup comparison of the changes from pre- to postintervention, only the TCR group showed a significant improvement in the phonemic fluency test (P=0.013).
TCR might be more effective than CCR in improving frontal lobe-related executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory.
TCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.
认知缺陷，尤其是执行功能障碍，在后天性脑损伤（ABI）后很常见，并且对日常生活中的功能状态和自主性有不利影响。在各种认知训练方法中，计算机化认知康复（CCR）已被研究为治疗师驱动的认知康复（TCR）的替代方法。然而，先前的研究表明 CCR 和 TCR 的优越性或劣等性存在矛盾的结果。
研究 TCR 和 CCR 在改善急性至亚急性 ABI 患者的执行功能方面的效果。
前瞻性、评估者盲法随机对照试验。
大学医院康复科的住院治疗环境。
32 名患有执行功能障碍的急性至亚急性（发病后不到 3 个月）ABI 患者纳入本研究。受伤后的平均时间为 25.1±18.1 天。
参与者被分配到 TCR 组（N=14）或 CCR 组（N=18）。每组在常规康复的基础上，每天进行 TCR 或 CCR 治疗 30 分钟，持续两周。在基线（T0）和治疗结束时（T1）进行神经认知功能测试，以评估复杂注意力、执行功能、一般认知功能（简易精神状态检查[MMSE]和蒙特利尔认知评估[MoCA]）和功能评估[改良巴氏指数，MBI]）。
TCR 和 CCR 组在 MMSE（P=0.004，0.000）、MoCA（P=0.003，0.006）和 MBI（P=0.000，0.000）评分方面均有显著改善。TCR 和 CCR 组在一些复杂注意力测试（连线测试 A，P=0.002，0.005）和执行功能测试（连线测试 B，P=0.016，0.016）中均有显著改善。TCR 组在额外的执行功能测试（语音流畅性测试，P=0.004，语义流畅性测试，P=0.001）中表现出显著改善，而 CCR 组在额外的复杂注意力测试（符号搜索，P=0.02，数字符号编码，P=0.002）中表现出显著改善。在干预前后的变化的组间比较中，只有 TCR 组在语音流畅性测试中表现出显著改善（P=0.013）。
TCR 可能比 CCR 更能有效改善 ABI 患者与额叶相关的执行功能。CCR 可能有益于改善精神运动速度和工作记忆。
应根据急性至亚急性 ABI 患者认知功能障碍的靶向域选择 TCR 或 CCR。
