脑卒中后单侧空间忽略对偏瘫康复疗效的影响

Influence of unilateral spatial neglect to the rehabilitation of hemiplegia

目的:探讨脑卒中后单侧空间忽略的发生及其对偏瘫康复疗效的影响。方法:对住入本院的脑卒中偏瘫患者采用神经心理学方法进行评测,确定18例单侧空间忽略患者为观察组,将27例无忽略的右侧大脑半球病变致脑卒中偏瘫患者列为对照组,两组均予常规康复治疗,并在治疗前后进行简式Fugl-Meyer运动功能评定(FMA)、功能独立性评定(FIM)、简易精神状态检查(MMSE)。结果:观察组的MMSE评分在治疗后虽有提高(P<0.05),但其FMA、FIM评分无明显提高(P>0.05),治疗前后FMA、FIM、MMSE均明显低于对照组(P<0.05或P<0.01)。结论:单侧空间忽略的存在直接影响了脑卒中偏瘫康复疗效,常规康复治疗无助于提高日常生活活动能力。

Objective:To study the occurrence of unilateral spatial neglect(USN) and its effect on the rehabilitation after stroke with hemiplegia.Method:Stroke patients with hemiplegia were evaluated by neuropsychological test and 18 right hemispheric stroke patients out of them identified with USN as an observation group. 27 right hemispheric stroke patients without USN served as a control group. Both two groups received conventional rehabilitation therapy and evaluated by Fugl-Meyer motor scale(FMA), Functional Independence Measure(FIM), Mini Mental Status Examination(MMSE) before and after rehabilitation.Result:Patients in the observation group scored significantly lower with FMA?FIM?MMSE than those in the control group(P<0.05 or P<0.01) before and after treatment. After treatment, the patients in the observation group scored significantly higher with MMSE(P<0.05), but not significantly higher with FMA?FIM(P>0.05).Conclusion:The presence of USN is a well established adverse prognostic factor for their conventional rehabilitation which hinder the improvement on activities of daily living(ADL). It's important to aim at the type-specific rehabilitation approaches and to explore the assessment tool.