认知康复整体模式和一般康复训练:对颅脑损伤患者认知恢复的远期评估

Long-term effect of cognitive rehabilitation-whole pattern training and common rehabilitation on the cognitive recovery of patients with head injury

目的:比较应用纽约大学认知康复模式训练和一般认知康复训练对脑损伤患者认知功能恢复的效果。方法:以1994-10/2004-07青海省人民医院收治的颅脑损伤患者123例为观察对象,根据经济能力和患者意愿分为整体模式组62例和一般认知训练组61例。①整体模式组患者病情稳定5d后应用纽约大学认知功能训练模式进行认知功能恢复训练:第1个阶段包括初级评定期,强化治疗期和再评定期3个时期,20周为1个周期;第2个阶段为指导就业尝试阶段,一般为3～6个月,训练方式有治疗师与患者一对一训练,同类患者在一起集体治疗和治疗师、患者及患者亲属朋友在一起的治疗性社团活动3种形式。②一般认知训练组10例左右患者分为1个小组,由治疗师带领,进行认知康复训练,4周为1个周期,一般进行6个周期。③所有患者治疗前和治疗后8个月运用慢性神经系统疾病患者认知功能障碍检查问卷(30个问题,每答对一个问题得1分,总分为30分,≤20分为异常)进行认知功能测评。结果:按意向处理分析,123例全部进入结果分析。①治疗前两组患者慢性神经系统疾病患者认知功能障碍检查问卷得分无差异(11.1±3.6,10.9±3.5,t=0.212,P>0.05)。②治疗8个月后整体模式组显著高于一般认知训练组(25.3±2.3,18.6±3.1,t=3.165,P<0.01)。结论:规范的纽约大学认知康复模式用于颅脑损伤患者认知康复训练中,首先建立在了解患者整体情况的基础上,且注意每个环节的连接和步骤的顺序安排,注重了患者的参与性,而一般康复训练缺乏对患者性格和积极性的了解,没有制订针对性的训练计划,因此整体模式的认知训练效果优于一般认知训练。

AIM： To compare the effect of the cognitive rehabilitation pattern training of New York University and the common cognitive rehabilitation training on the recovery of cognitive function in patients with head injury. METhODS： Totally 123 patients with head injury in Qinghai provincial People＇s Hospital between October 1994 and July 2004 were divided into whole pattern group （n=62） and common cognitive training group （n=61） according to their economic ability and will. ① In the whole pattern group, the patients received cognitive functional recovery training with the training pattern of cognitive function used by New York University at 5 days after the disease condition of the patients Was stable The 1st phase consisted of primary evaluation period, reinforced therapeutic period and reevaluation period, and 20 weeks as a cycle; The 2nd phase was the trial period for instruction of job hunting, which lasted for 3 to 6 months, the training manners included the one-to-one training between therapeutists and patients, group treatment of patients suffering from the same disease and the therapeutic association activities participated by the therapeutists, patients and their relatives and friends. ②In the common cognitive training group, 10 patients as a group received the cognitive rehabilitation training under the instruction of the therapeputists, 4 weeks as a cycle for 6 cycles. ③Before treatment and 8 months after treatment, the cognitive function of all the patients was assessed with the cognitive dysfunction questionnaire for patients with chronic neurological disease （consisted of 30 questions, 1 point for each question with right answer, the total score was 30 points, and ≤ 20 points was taken as abnormal）. RESULTS： According to intention-to-treat analysis, all the 123 cases were involved in the analysis of results. ①Before treatment, the score of the cognitive dysfunction questionnaire for patients with chronic neurological disease between the two groups had no difference （11.1±3.6, 10.9±3.5, t=0.212, P 〉 0.05）. ②Eight months after treatment, the score was significantly higher in the whole pattern group than in the common cognitive training group （25.3±2.3, 18.6±3.1, t=3.165, P 〈 0.01）. CONCLUSION： In the cognitive rehabilitation training of patients with head injury, the canonical cognitive rehabilitation pattern used by New York University is firstly established on the basis of knowledge of the patients＇ general condition, and it pays attention to the connection of each link and the arrangement of the procedure, and emphasizes the participation of the patients, but the common cognitive rehabilitation training is lack of the knowledge to the character and activity of the patients, and does set up the training plan according to the patients＇ condition. So the effect of the whole pattern cognitive training is superior to that of the common one.