Zusammenfassung
Exekutive Funktionen spielen für den funktionellen Rehabilitationserfolg und die soziale
Reintegration eine wichtige Rolle. Bisher liegen für die Therapie dieser Funktionen
kaum evidenzbasierte Therapieprogramme vor. Ziel dieses Überblicks ist es, die vorliegenden
Evaluationsstudien nach inhaltlichen Kriterien sowie nach den Prinzipien der Evidenzbasierten
Medizin (EbM) zu klassifizieren. Neben den EbM Kriterien werden Gruppengröße, Art
und Häufigkeit der Intervention und die Qualität der Ergebnisparameter erfasst. Dadurch
soll eine Bewertung, welche Interventionsmethoden bei welchen Störungen der Exekutivfunktionen
besonders erfolgreich sind, ermöglicht werden. Die vorliegenden Studien [1] können drei inhaltlichen Therapieansätzen zugeordnet werden: erstens solchen, bei
denen die Manipulation und Modifikation der Umwelt im Vordergrund steht, zweitens
solchen, bei denen das Verhaltensmanagement das zentrale Moment ist, und drittens
kognitiv übenden Therapieansätzen. Die Heterogenität der Therapieansätze fordert den
Einsatz unterschiedlicher Arten der Evaluation. Die Evaluationsstudien erreichen unterschiedliche
Evidenzklassen. Während die kognitiven Ansätze ein vergleichsweise hohes Evidenzniveau
erreichen, so stützen sich die Evaluationsstudien zum Verhaltensmanagement großteils
auf Einzelfallanalysen mit individuell erfassten Erfolgsparametern und erreichen nur
eine niedrige Evidenzklasse. Ansätze, die systematisch die Modifikation der Umwelt
untersuchen, liegen bisher nur in sehr geringer Anzahl vor. Abschließend wird diskutiert,
welche Therapieansätze den strengsten Evaluationskriterien entsprechend wirksam sind
und an welcher Stelle weiterhin großer Evaluationsbedarf besteht.
Abstract
The therapy of executive functions plays an essential role for the functional outcome
and the social reintegration. Nevertheless there is a lack of cognitive oriented and
evidence-based therapy programs. The purpose of our review is the classification of
the present evaluation studies with regard of the principles of evidence based medicine
(EbM) and of the content. Besides the EbM criteria the number of participants, the
kind and number of interventions, the types of etiology and the standardisation and
quality of the outcome parameters are measured. By that, an assessment should be possible,
which interventions are successful for what types of dysexecutive syndrome. The present
studies [1] belong to three different types of therapy: at first, a therapy form focussing on
manipulation and modification of the environment, second, a therapy form using behaviour
management and a third form, which is based on practise and cognitive interventions.
The heterogenity of the therapy forms makes different types of evaluation necessary.
The evaluation studies reach different classes of evidence. While the cognitive therapy
forms reach comparable high evidence classes, the evaluation studies about behaviour
management - mostly present as single case studies with individual outcome parameter
- reach only low evidence classes. Final, we discuss, which therapy forms are effective
using the strong evaluation criteria and at which point further conceptual task and
further research is useful.
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Dr. Sandra Verena Müller
Abteilung für Neuropsychologie · Otto-von-Guericke Universität Magdeburg
Postfach 4120
39016 Magdeburg
eMail: sandra.mueller@nat.uni-magdeburg.de
