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创伤性脑损伤的认知康复治疗:推进国家科学研究模型研究协议框架
In October 2011, the Institute of Medicine (IOM) released the report Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence, assessing the published evidence for the effectiveness of using cognitive rehabilitation therapy (CRT) to treat people with traumatic brain injury (TBI). TBI has gained increasing attention in the past 15 years because of its status as the signature wound of American military conflicts in Iraq and Afghanistan. Growing numbers of U.S. service members are suffering traumatic brain injuries and are surviving them, given that (a) the majority of traumatic brain injuries are mild and (b) lifesaving measures for more severe injuries have significantly improved. People with any level of injury can require ongoing health care in their recovery, helping them to regain (or compensate for) their losses of function and supporting their full integration into their social structure and an improved quality of life.
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中度至重度创伤性脑损伤成人多学科急性后康复
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10064-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers--patients and clinicians, health system leaders, and policymakers, among othersmake well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
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创伤性脑损伤和创伤后应激障碍的认知功能和情绪控制的独立和累积影响
Three areas emerged where the PTSD/mTBI participants showed strengths in executive control functions: (1) overriding conflicting response cues in a flanker task, (2) overcoming proactive interference in working memory (suppressing material that is no longer relevant), and (3) stopping a motor response that was already planned. These strengths are closely related to other executive functions that were weaker in the PTSD/mTBI participants. They showed pronounced deficits in (1) motor response inhibition, (2) consistency in responding, and (3) control over emotional reactions to trauma reminders. Although they were not uniformly impaired in multitasking, the patients showed behavioral and electrophysiological deficits in working memory retrieval that became apparent only when they performed a secondary task during the delay interval. Ultimately, these types of dissociations are informative for demonstrating that PTSD/mTBI can spare some important cognitive abilities. These strengths could be exploited in future developments of psychotherapy and cognitive rehabilitation techniques.