Article

OBJECTIVE: To determine whether the Short-Term Executive Plus (STEP) cognitive
rehabilitation program improves executive dysfunction after traumatic brain
injury (TBI). DESIGN: Randomized, waitlist controlled trial with minimization and
blinded outcome assessment. SETTING: Community. PARTICIPANTS: Participants with
TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time
since injury +/- SD, 12+/-14y; mean age +/- SD, 45+/-14y; 62% women; 76% white).
INTERVENTION: STEP program: 12 weeks (9h/wk) of group training in problem solving
and emotional regulation and individual sessions of attention and compensatory
strategies training. MAIN OUTCOME MEASURES: Factor analysis was used to create a
composite executive function measure using the Problem Solving Inventory, Frontal
Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and
Self-Awareness of Deficits Interview. Emotional regulation was assessed with the
Difficulties in Emotion Regulation Scale. The primary attention measure was the
Attention Rating and Monitoring Scale. Secondary measures included
neuropsychological measures of executive function, attention, and memory and
measures of affective distress, self-efficacy, social participation, and quality
of life. RESULTS: Intention-to-treat mixed-effects analyses revealed significant
treatment effects for the composite executive function measure (P=.008) and the
Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P=.016).
We found no between-group differences on the neuropsychological measures or on
measures of attention, emotional regulation, self-awareness, affective distress,
self-efficacy, participation, or quality of life. CONCLUSIONS: The STEP program
is efficacious in improving self-reported post-TBI executive function and problem
solving. Further research is needed to identify the roles of the different
components of the intervention and its effectiveness with different TBI
populations.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS