본문 바로가기
KERD
논문KCI 등재

외상성 뇌손상 환자의 인지-언어적 중재 효과에 대한 메타분석

Meta-Analysis of Cognitive-linguistic Intervention for Patients with Traumatic Brain Injury

이미숙
특수교육재활과학연구소 (The Research Institute for Special Education & Rehabilitation Science)|2015.09|특수교육재활과학연구|제54권 제3호|pp. 59-83|DOI http://dx.doi.org/10.15870/jsers.2015.09.54.3.59

1

조회

0

다운로드

7

인용

0

참고문헌

키워드

메타분석meta-analysisTBI인지-언어적 중재증거 기반적 자료cognitive-linguistic interventionevidence-based information
주제분류기타사회과학

초록

TBI 이후에는 특이한 인지-언어적 양상이 나타나는데, 이는 다른 신경언어 장애군과 이질적인 속성을 띠기 때문에 치료 시 복합적인 고려가 요구된다. 이로 인해 TBI 환자를 대상으로 한 다각적인 인지-언어적 중재가 시도되고 있으나, 중재 효과에 대한 체계적인 분석은 아직 미흡한 실정이다. 특히, 국내의 경우 TBI의 인지-언어적 중재와 관련된 연구 자체가 적어 중재 효과에 관한 문헌 검토 및 메타분석 연구 역시 매우 드문 편이다. 본 연구에서는 TBI 환자를 대상으로 실시한 인지-언어적 중재의 효과에 관한 국내외 문헌들을 체계적으로 검토하고, 메타분석을 통해 그 효과성을 입증하고자 하였다. 이를 위해 1990년부터 2015년 사이에 게재된 TBI의 인지-언어적 중재 관련 연구들을 대상으로 총 609개의 논문을 1차적으로 선정한 후, 포함 준거 절차에 따라 최종적으로 16개의 논문을 분석하였다. 연구의 질적 분석 결과, TBI의 인지-언어적 중재는 청소년과 성인이 주요 대상자였으며, 중재의 하위 영역으로는 기억력, 언어 능력, 집행기능, 문제해결력 등의 순으로 많았다. 메타분석 결과, 인지-언어적 중재의 평균 효과크기는 .61로 유의한 수준이었으며, ‘중간’ 정도의 중재 효과가 있었다. 하위 영역 중에서는 기억력, 문제해결력, 집행기능, 언어 능력 등에서 집단 간 유의한 효과가 나타났다. 효과크기 측면에서는 추론력과 기억력이 ‘큰’ 정도의 효과크기를 갖는 것으로 분석되었다. 본 연구를 통해 TBI 환자를 대상으로 한 인지-언어적 중재는 효과적인 수준이며, 인지 및 언어 능력의 향상에 긍정적으로 기여함을 알 수 있었다. 본 연구는 TBI 환자에 대한 인지-언어적 중재의 효과성을 체계적으로 분석함으로써 증거 기반적 자료를 제공할 수 있다는 점에서 큰 의의가 있다.

Abstract

Patients with TBI have unique cognitive-linguistic aspects compared to other neurological disorders, and so we should treat them with caution. Although there are increasingly cognitive-linguistic interventions after TBI, the efficacy of them is rarely examined. Especially, domestic studies by systematic literature review or meta-analysis were hardly performed. The purpose of our study was to evaluate the extensive literature on the efficacy of cognitive-linguistic intervention systematically using a meta-analysis method. Sixteen studies, meeting the inclusion criteria, were entered into the analysis. There were four main findings. Firstly, the general target population for the cognitive-linguistic intervention was adolescents and adults. Secondly, most treatments included domains like memory, language, executive func tion, and problem solving. Thirdly, the results of meta-analysis indicated that a cognitive-linguistic intervention was generally effective for patients with TBI(g= .61, p<.01). Lastly, TBI patients had positive effects on memory, problem solving, executive function, language, and overall cognition. Additionally, reasoning and memory had largest effect size of all domains. The results from the current study suggest that the cognitive-linguistic interventions are effective and beneficial for patients with TBI in improving their cognition and language abilities. Our study also provides evidence -based information to support cognitive-linguistic rehabilitation after TBI.

참고문헌 (89)

  1. 김명헌, "경증 외상성 뇌손상 환자에서 신체적 증상, 우울, 불안과 인지기능의 관계", 생물정신의학, 15(3), pp.194~203 (2008), 대한생물정신의학회
  2. 안기옥, "사회경제적 수준에 따른 외상성 두부손상의 발생 및 중증도 분석", 박사, 의학, pp.2007
  3. 이미숙, "외상성 뇌손상 및 우반구 손상 환자의 인지-의사소통 능력 평가도구에 관한 문헌 고찰", 한국콘텐츠학회 논문지, 11(4), pp.253~262 (2011), 한국콘텐츠학회
  4. 이미숙, "외상성 뇌손상 환자의 인지-화용언어 능력 평가도구 개발을 위한 신뢰도 및 타당도 연구", 한국콘텐츠학회 논문지, 13(2), pp.370~377 (2013), 한국콘텐츠학회[DOI]
  5. 정재훈, "외상성 뇌손상 환자에서 기억기능의 결손: Rey-Kim 기억검사 Ⅱ를 중심으로", 특수교육재활과학연구, 54(2), pp.385~403 (2015), 특수교육재활과학연구소[DOI]
  6. Anderson, V., "Outcome from mild head injury in young children : a prospective study", Journal of Clinical and Experimental Neurop sychology, 23(6), pp.705~717 (2001)
  7. Body, R., "Communication disorders following trau matic brain injury", pp.81~112 (2004), Psychology Press
  8. Borenstein, M., "Introduction to metaanalysis" (2009), John Wiley & Sons
  9. Borgaro, S. R., "Cognitive and affective sequelae in complicated and uncomplicated mild traumatic brain injury", Brain Injury, 17(3), pp.189~198 (2003)
  10. Catroppa, C., "Rehabilitation of executive skills post-childhood traumatic brain injury(TBI) : a pilot intervention study", Developmental Neurorehabilitation, 12(5), pp.361~369 (2009)
  11. Chen, A. J. W., "Functional reintegration of prefrontal neural networks for enhancing recovery after brain injury", Journal of Head Trauma Rehabilitation, 21(2), pp.107~118 (2006)
  12. Chen, S. H., "The effectiveness of computer-assisted cognitive rehabilitation for persons with traumatic brain injury", Brain Injury, 11(3), pp.197~209 (1997)
  13. Cicerone, K. D., "Remediation of ‘‘working attention’’ in mild traumatic brain injury", Brain Injury, 16, pp.185~195 (2002)
  14. Cicerone, K. D., "Evidence based cognitive rehabilitation : recommendations for clinical practice", Archives Physical Medicine and Rehabilitation, 81, pp.1596~1615 (2000)
  15. Cicerone, K. D., "Evidence based cognitive rehabilitation : updated review of the literature from 1998 through 2002", Archives Physical Medicine and Rehabilitation, 86, pp.1681~1692 (2005)
  16. Cicerone, K. D., "Evidence-based cognitive rehabilitation : updated review of the literature from 2003 through 2008", Archives Physical Medicine and Rehabilitation, 92(4), pp.519~530 (2011)
  17. Cicerone, K. D., "Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury", Archives Physical Medicine and Rehabilitation, 85, pp.943~950 (2004)
  18. Cicerone, K. D., "A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury", Archives Physical Medicine and Rehabilitation, 89(12), pp.2239~2249 (2008)
  19. Coelho, C. A., "Management of discourse deficits following traumatic brain injury: progress, caveats, and needs", Seminars in Speech and Language, 28(2), pp.122~135 (2007)
  20. Coelho, C. A., "Treatment efficacy : cognitive-communicative disorders resulting from traumatic brain injury in adults", Journal of Speech and Hearing Research, 39(5), pp.5~17 (1996)
  21. Cohen, J., "Statistical power analysis for the behavioral sciences" (1988), Erlbaum
  22. Constantinidou, F., "Benefits of categorization training in patients with traumatic brain injury during post-acute rehabilitation : additional evidence from a randomized controlled trial", Journal of Head Trauma Rehabilitation, 23(5), pp.312~328 (2008)
  23. Cook, L. G., "Social and communication disorders following traumatic brain injury" (2013), Psychology Press
  24. Cornis-Pop, M., "Guest editorial : Cognitive-communication rehabilitation for combat-related mild traumatic brain injury", Journal of Rehabilitation Research and Development, 49(7), pp.11~32 (2012)
  25. Dahlberg, C. A., "Treatment efficacy of social communication skills training after traumatic brain injury : a randomized treatment and deferred treatment controlled trial", Archives Physical Medicine and Rehabilitation, 88(12), pp.1561~1573 (2007)
  26. Demir, S. O., "Functional and cognitive progress in aphasic patients with traumatic brain injury during post-acute phase", Brain Injury, 20, pp.1383~1390 (2006)
  27. D’Esposito, M., "Neural mechanisms of prefrontal cortical function : im plications for cognitive rehabilitation", Progress in Brain Research, 157, pp.123~392 (2006)
  28. Dou, Z. L., "Computerized errorless learning-based memory rehabilitation for Chinese patients with brain injury : a preliminary quasiexperimental clinical design study", Brain Injury, 20, pp.219~225 (2006)
  29. Elliott, M., "Efficacy of memory rehabilitation therapy : a meta-analysis of TBI and stroke cognitive rehabilitation literature", Brain Injury, 28(12), pp.1610~1616 (2014)
  30. Fish, J., "Rehabilitation of executive dysfunction following brain injury : "contentfree"cueing improves everyday prospective memory performance", Neuropsychologia, 45, pp.1318~1330 (2007)
  31. Gavett, B. E., "Chronic traumatic encephalopathy : a potential late effect of sport-related concussive and subconcussive head trauma", Clinics in Sports Medicine, 30, pp.179~188 (2011)
  32. Gersten, R., "Quality indicators for group experimental and quasi-experimental research in special education", Excep tional Children, 71(2), pp.149~164 (2005)
  33. Geusgens, C. A., "Occurrence and measurement of transfer in cognitive rehabilitation : a critical review", Journal of Rehabili tation Medicine, 39(6), pp.425~439 (2007)
  34. Goldstein, F. C., "Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults", Journal of the International Neuropsychological Society, 7(3), pp.373~383 (2001)
  35. Gordon, W. A., "Treatment of post-TBI executive dys function : application of theory to clinical practice", Journal of Head Trauma Rehabilitation, 21, pp.156~167 (2006)
  36. Hanten, G., "Childhood head injury and metacognitive processes in language and memory", Develop mental Neuropsychology, 25(1, pp.2) (2004), 85~106
  37. Hart, T., "Use of a portable voice organizer to remember therapy goals in traumatic brain injury rehabilitation : a within-subjects trial", Journal of Head Trauma Rehabilitation, 17, pp.556~570 (2002)
  38. Helmick, K., "Cognitive rehabilitation for military personnel with mild traumatic brain injury and chronic post-concussional disorder: results of April 2009 consensus conference", Neuro Rehabilitation, 26(3), pp.239~255 (2009)
  39. Hewitt, J., "Theory driven rehabilitation of executive func tioning : improving planning skills in people with traumatic brain injury through the use of an autobiographical memory cueing procedure", Neuropsychologia, 44, pp.1468~1474 (2006)
  40. Hinchliffe, F. J., "Towards a conceptualisation of language and cognitive impairment in closed head injury : use of clinical measures", Brain Injury, 12, pp.109~132 (1998)
  41. Hinchliffe, F. J., "Cognitive-linguistic subgroups in closed head injury", Brain Injury, 12, pp.369~398 (1998)
  42. Hinchliffe, F. J., "Traumatic brain-injury associated speech, language and swallowing disorders" (2001), Thomson Delmar
  43. Hoskison, M. M., "Persistent working memory dysfunction following traumatic brain injury : evidence for a time-dependent mechanism", Neuroscience, 159, pp.483~491 (2009)
  44. Karr, J. E., "The neuropsychological outcomes of concussion : a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury", Neuropsychology, 28(3), pp.321~336 (2014)
  45. Kennedy, M. R., "Self-regulation after traumatic brain injury : a framework for intervention of memory and problem solving", Seminars in Speech and Language, 26, pp.242~255 (2005)
  46. Kennedy, M. R., "Intervention for executive functions after traumatic brain injury : a systematic review, meta-analysis and clinical recommendations", Neuropsychological Rehabi litation, 18, pp.257~299 (2008)
  47. Kennedy, M. R., "INCOG recommendations for management of cognition following traumatic brain injury, part III : executive function and self-awareness", Journal of Head Trauma Rehabilitation, 29(4), pp.338~352 (2014)
  48. Kimbarow, M. L., "Cognitive Communication Disorders", pp.219~233 (2011), Plural Publishing
  49. Krause, M., "Supporting the literacy skills of adolescents with traumatic brain injury", Seminars in Speech and Language, 36(1), pp.60~73 (2015)
  50. Kurowski, B. G., "Long-term benefits of an early online problem-solving intervention for executive dysfunction after traumatic brain injury in children : a randomized clinical trial", JAMA Pediatrics, 168(6), pp.523~531 (2014)
  51. Laatsch, L., "Changes in fMRI activation following rehabilitation of reading and visual processing deficits in subjects with traumatic brain injury", Brain Injury, 20, pp.1367~1375 (2006)
  52. Levine, B., "Rehabilitation of executive functioning : an experimental-clinical validation of goal management training", Journal of the International Neuropsychological Society, 6, pp.299~312 (2000)
  53. LoPresti, E. F., "Assistive technology for cognitive rehabili tation : state of the art", Neuropsychological Rehabilitation, 14, pp.5~39 (2004)
  54. Manly, T., "Rehabilitation of executive function : facilitation of effective goal management on complex tasks using periodic auditory alerts", Neuropsychologia, 40, pp.271~281 (2002)
  55. McKee, A. C., "Chronic traumatic encephalopathy in athletes : progressive tauopathy after repetitive head injury", Journal of Neuropathology and Experimental Neurology, 68, pp.709~735 (2009)
  56. Moran, C., "Language and memory profiles of adolescents with traumatic brain injury", Brain Injury, 8, pp.273~288 (2004)
  57. Murdoch, B. E., "Traumatic brain injury: associated speech, language, and swallowing disorders", pp.1~23 (2001), Singular Thomson Learning
  58. O’Neill, B. O., "The efficacy of contralesional limb activation in rehabili tation of unilateral hemiplegia and visual neglect : a baseline-intervention study", Neuropsychological Rehabilitation, 14, pp.437~447 (2004)
  59. O’Neil-Pirozzi, T. M., "A controlled treatment study of internal memory strategies(I-MEMS)following traumatic brain injury", Journal of Head Trauma Rehabilitation, 25(1), pp.43~51 (2010)
  60. Orwin, R., "A fail-safe N for effect size in meta-analysis", Journal of Educational Statistics, 8, pp.157~159 (1983)
  61. Paniak, C., "A randomized trial of two treatments for mild traumatic brain injury", Brain Injury, 12(12), pp.1011~1023 (1998)
  62. Pero, S., "Rehabilitation of attention in two patients with traumatic brain injury by means of ‘attention process training’", Brain Injury, 20, pp.1207~1219 (2006)
  63. Potvin, M. J., "Prospective memory rehabilitation based on visual imagery techniques", Neuropsychological Rehabilitation, 21(6), pp.899~924 (2011)
  64. Rath, J. F., "Group treatment of problem-solving deficits in outpatients with traumatic brain injury : a randomised outcome study", Neuropsychological Rehabilitation, 13, pp.461~488 (2003)
  65. Rosenthal, R., "The file drawer problem and tolerance for null results", Psychological Bulletin, 86, pp.638~641 (1979)
  66. Serino, A., "A pilot study for rehabilitation of central executive deficits after traumatic brain injury", Brain Injury, 21, pp.11~19 (2007)
  67. Shum, D., "A randomized controlled trial of prospective memory rehabilitation in adults with traumatic brain injury", Journal of Rehabili tation Medicine, 43, pp.216~223 (2011)
  68. Sohlberg, M. M., "Attention Process Training-2 Test" (2001), Lash & Associates
  69. Sohlberg, M. M., "Cognitive rehabilitation: an integrative neuropsychological approach" (2001), The Guilford Press
  70. Sohlberg, M. M., "Background and initial case studies into the effects of prospective memory training", Brain Injury, 6, pp.129~138 (1992)
  71. Thornton, K. E., "Efficacy of traumatic brain injury rehabilitation : inter ventions of QEEG-guided biofeedback, computers, strategies, and medications", Applied Psy chophysiology and Biofeedback, 33, pp.101~124 (2008)
  72. Tiersky, L. A., "A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury", Archives Physical Medicine and Rehabilitation, 86, pp.1565~1574 (2005)
  73. Togher, L., "Training communication partners of people with traumatic brain injury : a randomized controlled trial", Aphasiology, 18(4), pp.313~335 (2004)
  74. Tsaousides, T., "Cognitive rehabilitation following traumatic brain injury : assessment to treatment", Mount Sinai Journal of Medicine, 76, pp.173~181 (2009)
  75. Tsaousides, T., "Traumatic Brain Injury: Rehabilitative Treatment and Case Mana gement" (2010), Taylor & Francis press
  76. Turkstra, L. S., "Pragmatic communication deficits in adolescents and adults", Twin Cities Speech -Language Pathologists Annual Special Presentation, ~ (2009)
  77. Twamley, E. W., "Cognitive Symptom Management and Rehabilitation Therapy(CogSMART)for veterans with traumatic brain injury : pilot randomized controlled trial", Journal of Rehabilitation Research and Development, 51(1), pp.59~70 (2014)
  78. Vanderploeg, R. D., "Rehabilitation of traumatic brain injury in active duty military personnel and veterans : Defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches", Archives Physical Medicine and Rehabilitation, 89(12), pp.2227~2238 (2008)
  79. Vas, A. K., "Reasoning training in veteran and civilian traumatic brain injury with persistent mild impairment", Neuropsychological Rehabili tation, 27, pp.1~30 (2015)
  80. Vas, A. K., "Higher-order reasoning training years after traumatic brain injury in adults", Journal of Head Trauma Rehabilitation, 26(3), pp.224~239 (2011)
  81. Wade, S. L., "A randomized trial of teen online problem solving for improving executive function deficits following pediatric traumatic brain injury", Journal of Head Trauma Rehabilitation, 25(6), pp.409~415 (2010)
  82. Waid-Ebbs, J. K., "Response to goal management training in veterans with blast-related mild traumatic brain injury", Rehabilitation Research and Development, 51(10), pp.1555~1566 (2014)
  83. Waltz, J. A., "A system for relational reasoning in human prefrontal cortex", Psychological Science, 10, pp.119~125 (1999)
  84. Whelan, B. M., "Delineating communication impairments asso ciated with mild traumatic brain injury : a case report", Journal of Head Trauma Rehabilitation, 22(3), pp.192~197 (2007)
  85. Wilson, B. A., "A randomized control trial to evaluate a paging system for people with traumatic brain injury", Brain Injury, 19, pp.891~894 (2005)
  86. Ylvisaker, M., "Traumatic Brain Injury Rehabilitation: Children and Adolescents" (1998), Butterworth-Heinemann
  87. Ylvisaker, M., "Positive supports for people who experience behavioral and cognitive disability after brain injury : a review", Journal of Head Trauma Reha bilitation, 18(1), pp.7~32 (2003)
  88. Ylvisaker, M., "Language intervention strategies in aphasia and related neurogenic communication disorders" (2001), Lippincott, Williams & Wilkins
  89. Zencius, A. H., "Improving orientation in head injured adults by repeated practice, multi-sensory input and peer participation", Brain Injury, 12, pp.53~61 (1998)

관련 논문AI추천

실어증 환자의 인지능력 프로파일: 체계적 고찰 및 메타분석이미숙특수교육재활과학연구소 · 특수교육재활과학연구2016 · 제55권 제1호뇌손상의 심각도와 뇌병변의 편재화가 외상성 뇌손상 환자의 인지기능에 미치는 영향곽은희, 오경자한국임상심리학회 · Korean Journal of Clinical Psychology2012 · 제31권 제1호경도인지장애 성인 대상의 다분야 중재 및 언어기능 개선에 대한 국내 문헌 연구장찬, 김소담, 윤지혜특수교육재활과학연구소 · 특수교육재활과학연구2023 · 제62권 제3호국내 성인 실어증 치료 동향에 관한 문헌 고찰손은남, 이옥분인문사회 21 · 인문사회 212022 · 제13권 제6호노인에 대한 인지-언어적 중재 효과이미숙한국청각언어재활학회 · Audiology and Speech Research2018 · 제14권 제2호언어장애가 있는 외상성 뇌손상 환자의 이름대기 능력곽지영, 국승희한국임상심리학회 · Korean Journal of Clinical Psychology2002 · 제21권 제1호

이 간행물의 다른 논문 (25건)

일반 중등학교 특수학급 교사들이 인식하는 특수교사 정체성에 관한 연구강종구pp. 1-23특수교육 교육과정 중학교 진로와 직업과에 나타난 자기결정 요소 분석박상희pp. 25-43아급성기 뇌졸중 환자들의 축소형 동적 보행 지수(Dynamic Gait Index-4item)의 측정자간ㆍ내 신뢰도와 경시적 구성 타당도박창식pp. 45-58농인에 대한 우리나라 성인의 인식 연구정승희pp. 85-103학교부적응 고등학생을 위한 긍정심리중심 집단미술치료가 자아탄력성과 학교생활적응에 미치는 효과윤효운, 김귀화pp. 105-126
원문 보기