认知行为疗法对认知障碍偏瘫患者功能康复的作用

Action on Motor Function Score Among Cognitive Impairment Hemiplegia with Cognitive Behavior Therapy

目的:运用认知行为疗法对脑卒中后认知障碍患者的干预,观察其对偏瘫患者恢复肢体功能和ADL能力方面的影响。方法:将116例患者根据简易智力状态检查(MMSE)的评定结果分为2组,MMSE积分低于24分者为认知治疗组共46例,其余为对照组共70例。2组患者在接受康复治疗的前后,均进行相关的功能评定,包括偏瘫肢体综合功能评定(上田敏法)、日常生活活动能力ADL评定(改良Barthel指数法)、认知状况采用MMSE。2组患者均采用住院康复治疗,入院后所有患者均接受有关疾病的健康教育,同时每天进行1～2小时以上的一对一的功能康复训练,认知治疗组每天在常规康复治疗的基础上,运用认知行为疗法,结合强制性训练和集体医疗体操。结果:2组患者康复训练后,通过自身前后比较发现,综合肢体功能和ADL能力均有明显提高,且对照组积分普遍高于治疗组,但经统计学处理2组间并无显著性意义。结论:认知障碍是影响偏瘫患者康复疗效的一个重要因素,积极的心理治疗是康复治疗顺利进行的基本保证,有利于促进偏瘫患者的功能恢复。康复离不开心理治疗,心理治疗应贯穿康复过程始终。

Objective：To determine the effect of cognitive-behavior therapy on Motor function and scores of activities of daily living（ADL） among Hemiplegia with cognitive impairment.Methods：46 Hemiplegia with scores of MMSE lower than 24 and another 70 Hemiplegia without such problems were recruited as cognitive therapy group and controlled group.All patients were hospitalized and educated about the disease.They received function training for one or two hours everyday each by one therapist while patients in the cognitive therapy group were trained with cognitive and behavior therapy combined with constrain therapy and group medical gymnastics.Cognitive state,comprehensive motor function and activities of daily living were measured from MMSE and index of Barthel respectively before and after rehabilitation.Results：Both groups showed significant gains in comprehensive motor function and activities of daily living,while higher Scores of them were observed in the controlled group without any Statistics differences.Conclusions：Cognitive impairment should be an important factor that may effect the patients rehabilitation outcomes.So positive psycho-therapy would promote hemiplegia ambulatory rehabilitation and guarantee the smooth process of it.In all,Psycho-therapy is a necessary part of rehabilitation which should be included all along.