Background Executive functions are the controlling mechanisms of the brain and include the processes of planning, initiation, organisation, inhibition, problem solving, self monitoring and error correction. They are essential for goal-oriented behaviour and responding to new and novel situations. A high number of people with acquired brain injury, including around 75% of stroke survivors, will experience executive dysfunction. Executive dysfunction reduces capacity to regain independence in activities of daily living (ADL), particularly when alternative movement strategies are necessary to compensate for limb weakness. Improving executive function may lead to increased independence with ADL. There are various cognitive rehabilitation strategies for training executive function used within clinical practice and it is necessary to determine the effectiveness of these interventions. Objectives To determine the effects of cognitive rehabilitation on executive dysfunction for adults with stroke or other non-progressive acquired brain injuries.

This qualitative research explores the feelings of oncology patients nursed in protective isolation following high-dose chemotherapy. Five patients described their feelings about the isolation experience during audio-taped interviews lasting between a half and one hour. Tapes were transcribed and analysed, with emergent themes considered in relation to the other interviews and to the literature. The research findings indicate that cancer patients have specific concerns with regard to their experience in the isolation environment, which fall into four distinct categories of: 'being shut in'; 'coping with the experience'; 'being alone'; and 'maintaining contact with the outside world'. In addition, patients have concerns with regard to the experience of having cancer, that impinge upon the isolation experience. These are: 'having cancer'; 'suffering chemotherapy'; 'knowing what to expect'; and 'developing relationships with the health professionals'. The core variable is 'something that I have to go through'. The nature of the relationship between the categories led to the development of an integrative model for exploring the feelings of cancer patients nursed in isolation. Most of the informants coped well with the isolation experience and described feeling supported by the nursing staff. Their overriding concern in fact, reflected a desire to receive information about their disease and reassurance regarding their treatment. Being in isolation appears to inhibit communication about these issues.

E xecutive functions are cognitive processes essential for controlling goal-oriented behavior and responding to new and novel situations. Executive function includes the processes of planning, initiation, organization, inhibition, problem solving, self-monitoring, and error correction. It has been estimated that ≈75% of stroke survivors experience impaired executive function (executive dysfunction), resulting in reduced capacity to regain independence in activities of daily living, particularly when new movement strategies are necessary to compensate for limb weakness. A variety of cognitive rehabilitation interventions are implemented within clinical practice in an attempt to improve executive function and, consequently, independence with activities of daily living. ObjectivesTo determine the effects of cognitive rehabilitation on executive dysfunction for adults with stroke or other nonprogressive acquired brain injuries. MethodsWe searched: Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, and AMED (last search August 2012). We also searched an additional 11 databases, hand-searched journals and conference proceedings, and contacted experts.We included randomized trials in adults with stroke or other adult acquired brain injury in which the intervention was cognitive rehabilitation, and outcomes included executive function measures or cognitive outcome measures with separable executive function scores. The primary outcome of interest was measures of global executive function; secondary outcomes included assessments of specific components of executive function and activities of daily living.Two review authors independently screened abstracts, extracted data, and appraised trials. Assessments of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias were undertaken. For continuous data, we calculated the treatment effect using standardized mean differences and 95% confidence intervals where different studies used different scales for the assessment of the same outcome, and using mean differences and 95% confidence interval where studies all used the same method of measuring outcome. We used a random-effect model for all analyses. Main ResultsNineteen studies (907 participants) met the inclusion criteria for this review. Data were available for inclusion within meta-analyses from 13 studies (660 participants, including 234 with stroke) that investigated a range of interventions, including problem-solving training (6 studies), self-awareness or self-monitoring training (4 studies), general cognitive rehabilitation (2 studies), and working memory training (1 study).Six of the included studies (333 participants) compared cognitive rehabilitation with no treatment or placebo; none reported the primary outcome measure and data from 4 studies demonstrated no statistically significant effect of cognitive rehabilitation on secondary outcomes. Ten...