家庭康复干预对脑卒中患者日常生活活动及认知能力的影响

Effect of community-based-rehabilitation on activities of daily life and cognitive function in stroke patients

目的:观察社区家庭康复干预对脑卒中患者认知能力及日常生活活动能力的影响。方法:于2003/2005期间选择生活在郑州大学医院二院附近社区符合全国第四届脑血管病会议制定的脑卒中诊断标准的脑卒中患者45名,随机分为康复组25例和对照组20例。所有患者一般药物治疗相同,康复组进行社区家庭康复干预3个月。对患者瘫痪类型进行康复评估,制定相应康复治疗方案,采取运动功能训练、日常生活能力训练,同时进行心理康复和社会适应能力训练。运动功能训练包括患侧肢体各关节的被动运动、健患侧翻身练习、平衡功能训练(包括坐、站平衡训练)、体位转移(床-椅转移,坐-站转移)训练、步态训练(行走、上下楼梯)及腕踝关节背伸的牵张练习。日常生活活动能力训练包括进食、穿衣、个人卫生处理等。心理康复治疗和社会适应能力训练主要包括与患者建立良好的医患关系,帮助其增强信心、缓解负性情绪、指导和鼓励患者表达情感。干预频率2次/周。干预后运用简易智力状态检查评定患者认知能力,采用Barthel指数评定患者日常生活活动能力,由同一位医师在康复干预前后测评。结果:45例患者均进入结果分析。①康复干预前两组Barthel指数评分、简易智力状态检查量表评分差异无显著性意义(P>0.05)。康复干预后康复组Barthel指数评分、简易智力状态检查量表评分明显高于对照组,差异有显著性意义[(56.9±9.89),(49.8±9.87),t=2.413,P<0.05];[(26.6±4.60),(22.9±6.70),t=2.105,P<0.05]。②病程小于6个月的康复组患者康复后Barthel指数明显高于病程6～12个月及病程大于12个月患者的Barthel指数,差异有显著意义[(67.6±8.90),(59.1±7.20),t=2.397,P<0.05];[(67.6±8.90),(55.7±8.20),t=2.487,P<0.05]。结论:社区家庭康复能明显提高脑卒中患者的认知能力及日常生活活动能力,6个月内是脑卒中患者康复治疗的关键时期,及早康复有望使神经功能缺损减少到最小程度。

AIM： To observe the effect of community-based-rehabilitation （CBR） on cognitive function and activities of daily life （ADL） of stroke patients. METHODS： A total of 45 stroke patients diagnosed according to the evaluative standard revised by the Fourth Academic Conference of National Cerebral Vascular Disease and lived in communities around the Second Hospital of Zhengzhou University from 2003 to 2005 were selected and randomly divided into two groups： rehabilitation group （n=25） and control group （n =20）. Additionally to the same medication treatment, the rehabilitation group was treated by CBR for 3 months. Different recovered therapies were laid down according to the paralytic types of stroke patients, including motor function exercise, ADL training, psychological recovery and social adaptation training. The motor function exercise included passive motor of each joint of affected limbs, rolling exercise of affected part, balance ability training （sitting and standing balance）, position transfer exercise （bed-chair transfer and sit-stand transfer）, gait training （walking and stair activity） and stretching exercise of ankle of wrist. ADL training included food taking, putting on clothes, individual hygiene disposal and so on. Psychological recovery and social adaptation training included good relationship between doctors and patients to help them strengthen confidence, release negative emotion, instruct and courage them to express feelings. The intervention was performed twice a week. Then the cognition function was measured by mini mental state examination （MMSE） and ADL were assessed by Barthel index by the same physician before and after CBR. RESULTS： All the 45 patients were involved in the result analysis. ① Before CBR, there was no significant difference in the scores of MMSE and Barthel index between the two groups （P 〉 0.05）. But after CBR, the scores of the rehabilitationgroup were obviously higher than the control group [（56.9±9.89）, （49.8±9.87）, t=2.413, P 〈 0.05]; [（26.6±4.60）, （22.9±6.70）, t=2.105, P 〈 0.05]. ②In the rehabilitation group, the Barthel index of the patients whose course of disease was less than 6 months was higher than that of 6-12 months and more than 12 months, which had significant differences [（67.6±8.90）, （59.1 ±7.20）, t=2.397, P 〈 0.05]; [（67.6±8.90）, （55.7±8.20）, t=2.487, P 〈 0.05]. CONCLUSION： CBR can improve cognitive function and ADL of stroke patients, and less than 6 months is the key stage for treatment of stroke, early recovery can minimally decrease the neurological function defects.