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, Groupe de Recherche Clinique Handicap Cognitif et Réadaptation, Université Pierre et Marie Curie Paris 06 CNRS. INSERM, laboratoire d'imagerie biomédicale

, UPMC Paris 6

, Psychology: College of Life and Environmental Sciences

S. Hôpitaux-de and . Maurice, Service de Rééducation des Pathologies Neurologiques Acquises de l'Enfant, F-94410

, Université Pierre et Marie Curie Paris 06 CNRS. INSERM, laboratoire d'imagerie biomédicale

, UPMC Paris 6

, Royaume Uni) pour nous avoir communiqué les données préliminaires de l'étude Cogmed ® chez les enfants cérébro-lésés et pour son expertise sur ce domaine

, La difficulté et le type d'exercices étaient personnalisés et régulièrement (tous les 15 jours) réadaptés par les thérapeutes selon les progrès des enfants, et les fiches d'exercices remises à jour. Les fonctions exécutives n'ont pas été évaluées spécifiquement dans cette études mais le deuxième format de rééducation s'est révélé significativement plus efficace sur les progrès et moteurs et cognitifs (évalués par un test de Wechsler), qui était une donnée importante de cette étude incluant des enfants dans des parties reculées du Brésil où beaucoup de parents pouvaient être analphabètes)

Q. Executives,

«. Le and . Cogmed, Working Memory Training® » est l'entrainement de la mémoire de travail le plus utilisé et ayant fait l'objet de très nombreuses études, principalement chez l'enfant avec Trouble Déficitaire de l'Attention/Hyperactivité (TDA/H), Cogmed ® peut être recommandé, bien que certaines données soient contradictoires en raison de biais méthodologiques de

, Les données de la littérature montrent que Cogmed ® peut améliorer la MT verbale et visuo-spatiale et la mémoire à court terme visuo-spatiale chez les enfants avec TDA/H (voir étude de Holmes, 2010.

, Cogmed ® améliore la mémoire à court terme visuo-spatiale (et cet effet est maintenu 3 mois après l'intervention). La lecture s'améliore à 3 mois uniquement. A ce jour il n'y a pas à notre connaissance d'études montrant l

, Cogmed ® sur les FE proprement dites chez les enfants cérébro-lésés. L'avantage de cette méthode est qu'elle peut être effectuée par l'enfant seul, devant un ordinateur, à l'heure et dans le lieu qui arrange la famille, sous la supervision régulière (éventuellement à distance par téléphone) d'un thérapeute. Le thérapeute reçoit un feedback de la compliance au programme méthode, mais il pourrait s'agir de méthodes d'avenir

L. Enfant,

, Les limites de la plupart des méthodes de rééducation publiées sont nombreuses

, Une tâche évaluant les FE doit être nouvelle, non apprise, non automatisée, sans quoi elle n'évalue plus les FE en tant que telles 22,229,367 . De plus, à force d'utiliser en rééducation des exercices inspirés du « Stroop » ou de tests de classement de formes (Wisonsin Card Sorting Test, exercice du Cogntive Remediation Therapy), nos tests d'évaluation risquent de perdre en validité et cela peut fausser les résultats des bilans, Beaucoup d'études utilisent le même type d'exercices pour l'entrainement et l'évaluation post rééducation

, étude du Goal Mangement Training par exemple 200 , les enfants semblaient s'être améliorés sur la tâche écologique du gâteau au chocolat 120,121 mais lorsqu'ils ont été confrontés à une nouvelle recette ayant le même nombre d'étapes, le même nombre d'ingrédients et présentée sous la même forme dans le même lieu, ils revenaient au nombre d'erreurs qu'ils avaient faites avant la rééducation. La généralisation à des tâches non travaillées, et surtout à des tâches écologiques et au contexte de l'enfant est insuffisamment évaluée, Pour les FE on ne devrait utiliser un test qu'une fois si on veut évaluer l'adaptation à une situation non routinière

, Le transfert au contexte de l'enfant et la généralisation à des tâches écologiques sont insuffisamment évalués. Les critères de jugement ne peuvent être constitués uniquement d'exercices papier-crayon

, Les études portant sur des approches globales qui pourrait avoir un effet sur les FE, n'évaluent pas souvent le progrès sur le FE proprement dites 267, p.382