WESTPORT, CT (Reuters Health) Apr 09 - Giving brain-injured patients real-life skills training may be more effective than trying to directly rehabilitate damaged brain function, a comprehensive review of the literature has found.
A team of Canadian psychologists conducted a meta-analysis of 30 studies involving 359 patients with attention deficits due to brain injuries such as trauma or stroke.
"We compared two different approaches to treatment," lead author Dr. Norman W. Park, of Baycrest Centre for Geriatric Care, in Toronto, told Reuters Health. "One is a restoration-training-based approach, which assumes you can restore neural function; the other is a skills-based approach which assumes you can teach people compensatory strategies which enable them to function."
He reports with Dr. Janet L. Ingles, of Dalhousie University, in Halifax, Nova Scotia, in the April issue of the journal Neuropsychology, that programs in which patients are taught to relearn practical skills and to develop compensatory pathways had better results than those that used abstract exercises to attempt to directly restore damaged areas of the brain.
The researchers concluded that studies using the restoration-training-based approach are mainly flawed. In this approach, patients typically perform a task as a baseline, then are given some rehabilitative exercises which attempt to improve their ability to concentrate, and then to repeat the original task at a later period. The investigators found that when these patients were compared with those who performed both tests but had not received rehabilitation in the interim, the relative improvement in patients who had been treated all but disappeared.
After reviewing 26 such studies, Dr. Park concluded that most of the effect of rehabilitation was actually due to patients' getting to practice these skills, rather than any actual improvement in brain function. "There wasn't an improvement in performance that could be attributed to the treatment," he said.
The other four studies used specific skills retraining, and these showed significant improvement in performance of tasks requiring attention.
"Both approaches obviously claim there are brain changes [from rehabilitation]," Dr. Park said. "The claim I'm making is these changes are in relatively spared regions of the brain, [whereas others] would say, no, under some circumstances, they can change that part of the brain which has been damaged."
"This article," he said, "will force people actively engaged in [direct-retraining] research to examine whether this assumption is justified. The onus is on them to specify more clearly what those circumstances are that you can restore function — what types of patients and treatments."
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