认知康复对脑卒中偏瘫患者功能独立的影响

Effect of cognitive rehabilitation on the functional independence of hemiplegic patients with stroke

目的:分析认知功能障碍对脑卒中患者康复效益的影响及认知功能训练对患者运动功能的康复及其功能独立的影响。方法:于2003-08/2005-05选择中山大学附属第一医院康复科及神经科住院的初发脑卒中患者60例为观察对象,随机分为观察组和对照组,每组30例。对照组采用应用Bobath、Brunnstrum、Rood等技术对患者进行姿势摆放、异常姿势控制、体位转移、站立训练、平衡训练、步态训练及上肢功能训练和日常生活能力训练等物理治疗及作业治疗。观察组则在上述治疗的同时认知训练,包括注意力、记忆力、思维推理训练及失认症和失用症的矫正治疗。在治疗前后用洛文斯顿作业疗法认知评定成套测验(LOTCA)、简式Fugl-Meyer运动量表评定患者的认知、运动和功能独立能力,治疗前治疗后(出院时)采用功能独立的改变值与住院天数比值进行康复效益评定。结果:两组患者均完成治疗,全部进入结果分析。①观察组干预后认知、运动功能、功能独立均优于比对照组(P均<0.01)。②治疗前后运动的改善(即治疗前后简化Fugl-Meyer运动量表得分差值)与干预后认知功能及认知功能改善值(即治疗前后LOTCA差值)呈正相关关系,Pearson相关系数分别为0.596和0.404,P分别为0.000和0.001。③治疗后的功能独立能力与治疗后的认知功能和运动功能及治疗后认知功能的改善程度(即治疗前后LOTCA的差值)呈较高的正相关关系,Pearson相关系数分别为0.790,0.552和0.499,(P均<0.001)。治疗后的功能独立与治疗前的认知水平亦有一定的正相关关系,Pearson相关系数为0.279,P为0.015。④用逐步回归法筛选变量,康复效益与LOTCA改善值及治疗后运动功能存在线性关系,偏回归系数分别为0.009,0.006;P值分别为0.004,0.034,回归方程为Y=-0.0017+0.009X1+0.0006X2。结论:脑卒中患者的认知功能对运动功能及其功能独立有一定影响,认知功能的改善能提高康复效益,节约康复资源。

AIM： To analyze the influence of cognitive dysfunction on the rehabilitative efficacy of patients with stroke, and the effect of cognitive functional training on the rehabilitation of motor function and the functional independence of the patients. METHODS： Sixty inpatients with primary, stroke, who were selected from the Department of Rehabilitation and Department of Neurology. the First Affiliated Hospital of Sun Yat-sen University from August 2003 to April 2005, were randomly divided into observational group （n=30） and control group （n=30）. Patients in the control group were given physiotherapy and occupational therapy of posture holding, abnormal posture control, posture transfer, standing exercise, balance training, gait training, upper limb training and abilities of daily living training, etc; Besides, those in the observational group also received cognitive retraining according to their impairments, including attention and concentration training, memory retraining and teaching the patients strategies to compensate for the presence of apraxia and poor memory. The abilities of cognition, motor and functional independence of the patients were assessed with Loewenstein occupational therapy cognitive assessment （LOTCA） and Fugle-Meyer motor assessment （FMS） before and after treatment respectively, and the rehabilitative efficacy was evaluated by the ratio of the changed value of functional independence to the hospitalized days. RESULTS： All the patients in both groups finished the treatment, and entered the anlaysis of results. ① The cognitive and motor functions and the functional independence after intervention in the observational group were all superior to those in the control group （P 〈 0.01）. ② The improved value of motor （the value of difference of FMA score before and after treatment） before and after treatment had positive correlation with the cognitive function after intervention, and the improved value of cognitive function （the value of difference of LOTCA score before and after treatment）, the Pearson correlation coefficients were 0.596 and 0.404 respectively （P=0.000, 0.001）. ③ The ability of functional independence after treatment was highly and positively correlated with the cognitive and motor functions after treatment and the improved degree of cognitive function after treatment （the value of difference of LOTCA score before and after treatment）, and the Pearson correlation coefficients were 0.790, 0.552 and 0.499 respectively （P 〈 0.001）. The functional independence after treatment was also positively correlated with the cognitive level before treatment, and the Pearson correlation coefficient was 0.279 （P=0.015）. ④ The variables were screened by means of stepwise regression, there was linear correlation of rehabilitative efficacy with the improved value of LOTCA and motor function after treatment, the partial regression coefficients were 0.009 and 0.006 respectively （P=0.004, 0.034）, and the regression equation was Y=-0.001 7＋0.009X1＋0.000 6X2. CONCLUSION： The cognitive function of stroke patients has effects on their motor function and its functional independence, certain and the