声像图配套语言功能训练对脑卒中后运动性失语患者心理适应能力的改善:半年效果评估

Amelioration of the ability of mental adaptation in patients with poststroke Broca aphasia by using acoustic image speech rehabilitative training:Evaluation of half-a-year effect

目的:观察以声像训练为主的语言康复训练系统对脑卒中后运动性失语患者语言障碍和焦虑情绪的作用。方法:选取2002/2003哈尔滨医科大学附属第一医院神经内科的脑卒中后运动性失语患者60例,按患者意愿分为训练组和对照组各30例。两组药物治疗相同,训练组在此基础上利用自行设计的大幅挂图、卡片,结合电脑制作发音练习、字图、句图匹配,进行系统的语言训练,每次训练30～60min,每天必须接受1次训练,连续6个月,训练时要求家属参与,同时指导家属在训练时间外经常进行简单的训练。训练1,3及6个月时应用西方失语成套测验测定失语商(满分100分,分值高语言能力好),同时评估患者语言障碍程度(分为完全失语和重度、中度及轻度不完全失语);训练组训练前和训练6个月时应用汉密顿焦虑量表(14项,每项0～4分,总分<7分为无焦虑,>14分为肯定有焦虑)评估焦虑程度。结果:按意向处理分析,60例患者全部进入结果分析。①失语商:两组首次评估差异不显著,而1,3及6个月的评估结果,训练组均显著高于对照组(P<0.001)。②语言障碍恢复:训练组经训练后,其失语程度较对照组明显减轻,且有效率达到100%。③汉密顿焦虑量表评分:训练组经训练后总分较训练前显著下降(6.22±0.455,11.92±0.315,t=56.41,P<0.01),各症状评分均显著下降(P<0.01)。结论:早期采用以声像图为主的系统语言康复训练,能够促进脑卒中后运动性失语患者语言功能恢复,并可降低脑卒中的焦虑情绪,提高心理适应能力。

AIM： To observe the effects of speech rehabilitative training system mainly with acoustic image, on the language disorder and anxiety in patients with Broca aphasia caused by stroke.METHODS： Sixty patients with Broca aphasia caused by stroke in the Department of Neurology, the First Affiliated Hospital of Harbin Medical University in 2002 and 2003 were divided in to training group （n=30） and control group （n=30） according to their will. All the patients in both groups received the same drug therapy, besides those in the training group also received systematic speech training by using self-designed large map and cards combined with computer made pronunciation practice, matching of character and picture, sentence and picture, 30 to 60 minutes for each time, at least once every day for 6 continuous months. It required the participation of the relatives, meanwhile, the relatives were instructed to give simple training after training time usually. At 1, 3 and 6 months after training the aphasia quotient was assessed with the western aphasia set test respectively （total score was 100 points, the higher the score, the better the language ability）, the severity of language disorder was also evaluated （including complete aphasia, severe, moderate, mild and incomplete aphasia）.In the training group, the severity of anxiety was assessed with Hamilton anxiety scale （consisted of 14 items, 0 to 4 points for each item, total score〈 7 points was taken as without anxiety, 〉 14 points as certainly with anxiety）.RESULTS： According to intention-to-treat analysis, all the 60 patients were involved in the analysis of results. ① Aphasia quotient： There was insignificant difference for the 1st evaluation between the two groups, but it was significantly higher in the training group than in the control group for the evaluations at 1, 3 and 6 months （P 〈 0.01）. ② Recovery of language disorder： After training, the severity of aphasia in the training group was obviously relieved as compared with that in the control group, the effective rate reached 100%. ③ The score of Hamilton anxiety group： In the training group, the total score after training was significantly decreased as compared with that before training （6.22：t：0.455, 11.92：t：0.315, t=56.41, P〈 0.01）, the scores of the symptoms were all significantly decreased （P 〈 0.01）.CONCLUSION： The early application of systematic speech training mainly with acoustic image can promote the recovery of language function in the patients with Broca aphasia caused by stroke, reduce the emotion of pest-stroke anxiety, and improve their ability of mental adaptation.