无错性学习在脑损伤患者记忆功能恢复中的应用

Application of errorless learning in memory rehabilitation in patients with brain injury

目的∶评价在丰富的环境下进行无错性学习对脑损伤患者记忆恢复的作用,探讨此方法对记忆的哪个过程更有影响;比较电脑辅助的记忆训练与常规的治疗师主导的面对面训练是否存在差异。方法∶脑损伤患者30例为2004-03/12中山大学第三附属医院、中山大学第一附属医院、珠江医院、南方医院、广东药学院第一附属医院、广州市工伤康复中心等6家医院收治,均为脑损伤后3～6个月,年龄18～55岁,经评估后有记忆障碍患者,且病情平稳,注意力能维持在5min以上。30例患者随机分为计算机辅助训练组,治疗师主导的面对面训练组和对照组各10例。计算机辅助训练组和面对面训练组患者均在丰富的训练环境中接受20节记忆训练课程,1节/d,每节训练时长45min,5节/周,1个月内完成训练,所有课程是应用无错性学习方法设计的。对照组仅给予记忆训练指导性建议。训练前、后应用神经行为认知状态测评、Rivermead行为记忆测试、香港文字记忆测试(分为随机和成组条件下信息的编码、储存、提取等几个方面)等量表评患者的记忆功能,计算训练前后差值,比较训练效果。结果∶所有患者均完成训练。行为记忆测试总分计算机辅助训练组和面对面训练组优于对照组[(5.10±2.92),(3.70±2.58),(1.16±0.37)分,F=11.03,P=0.000]。训练前后行为认知状态测评?

AIM:To evaluate the effect of errorless learning on memory rehabilitation comb ined with enriched environment in patients with brain injury,study which memory process will be more effective by using this training method;and compare differe nce between computer assisted memory rehabilitation and a face to face therap ist administered programme of identical training content. METHODS:A total of 30 patients with memory retention disorder following brain injury were selected from Third Affiliated Hospital of Sun Yat sen University,Z hujiang Hospital,South Hospital,First Affiliated Hospital of Guangdong Medical C ollege,and Guangzhou Center for trauma Rehabilitation from March to December 200 4.They were all 18-55 years of age with stable condition following brain injury of 3-6 months,and their attention could lasted for more than 5 minutes.All 30 patients were divided randomly into three groups:computer assisted memory train ing group, therapist administered memory training group and control group,and 10 patients in each.The patients in computer assisted memory training and therapi st administered memory training groups were trained with 20 memory training cou rses related to errorless learning,one course per day for 45 minutes,and all the courses finished in one month.Patients in control group received introductions related to memory training.The neurobehavioral cognitive status examination,Rive rmead behavioral memory test and the Hong Kong list learning test(encoding, stor age and retrieval processes in random and block conditions) were used to test me mory function pre and post training.The difference was calculated to compare t he training effects. RESULTS:All patients finished the experiment.The total score on Rivermead beha vioral memory test in computer assisted memory training and therapist administe red memory training groups(5.10±2.92,3.70±2.58) increased significantly as com pared with that in control group(1.16±0.37,F=11.03,P=0.000).The score on differ ence of neurobehavioral cognitive status examination at pre and post training in computer assisted memory training and therapist administered memory training groups(2.00±2.26,2.90±2.23) was higher as compared with that in control group (0.90±0.73),but there was no significant difference(F=2.714,P=0.084).The score on random storage, encoding,and storage processes in computer assisted memory training group(3.75±3.03,2.83±2.11,3.90±3.79) increased obviously as compared with that in therapist administered memory training group(1.35±1.37,0.80±1.12 ,1.30±2.68) and control group(0.05±0.28,0.37±1.37,0.10±1.07).The score on en coding and retrieval processes after training was higher in computer assisted m emory training group(2.33±2.20,0.28±0.14) and therapist administered memory tr aining group(1.10±0.99,0.21±0.25) as compared with that in control group(0.33 ±0.72,0.07±0.11,P< 0.05). CONCLUSION:The errorless learning combined with enriched environment is a bett er method to improve memory function following brain injury.The errorless learni ng combined with computer assisted memory training can effectively improve the instant memory and ability of storage as compared with that combined with therap ist administered memory training.