脑外伤患者心理推理能力缺陷的认知性和技巧性干预:一项12周随机单盲对照试验

Effects of cognitive and skilled rehabilitative training on deficiencies of theory of mind in patients with traumatic brain injury: A 12-week random,single-blind clinical trial

目的:比较认知干预和技巧干预对脑外伤患者的心理推理能力和社会功能缺陷的疗效。方法:选取外伤后6个月以上的稳定期脑外伤患者90名,随机分成认知干预组(n=30)、技巧干预组(n=30)和对照组(n=30)。认知干预组采用针对患者现实生活表现的认知取向的生活事件讨论、情境扮演、家庭作业的方法进行康复训练,技巧干预组采用针对测试技巧的心理推理能力故事理解、图片理解的方法进行康复训练,对照组进行一般的门诊随诊服务。三组干预均为每周1次,共12周。干预前、干预后、干预结束后3个月采用心理推理能力经典任务、脑外伤患者心理推理能力他评量表、社会功能缺陷筛选量表(SDSS)评定三组患者的心理推理能力和社会功能。结果:干预前,三组患者各项得分差异无统计学意义(P>0.05)。干预后,认知干预组与技巧干预组的心理推理能力经典任务总分[(14.7±1.3),(15.2±1.7)vs.(12.5±1.6)]、脑外伤患者心理推理能力他评量表得分[(128.7±17.8),(126.8±17.9)vs.(109.5±16.5)]高于对照组(均P<0.05),SDSS得分低于对照组[(9.4±1.1),(10.0±1.0)vs.(12.1±1.3),P<0.05],认知干预组和技巧干预组间差异无统计学意义(P>0.05)。干预结束后3个月,认知干预组与技巧干预组的心理推理能力经典任务总分[(16.5±1.4),(15.9±1.2)vs.(13.3±1.5)]、脑外伤患者心理推理能力他评量表得分[(146.6±15.7),(134.5±14.6)vs.(115.8±21.2)]高于对照组(均P<0.05),SDSS得分低于对照组[(7.1±1.2),(8.0±0.9)vs.(11.4±0.8),P<0.05],认知干预组的他评量表得分高于技巧干预组[(146.6±15.7)vs.(134.5±14.6),P<0.05],SDSS得分低于技巧干预组[(7.1±1.2)vs.(8.0±0.9),P<0.05]。结论:认知干预和技巧干预均能提高脑外伤患者的心理推理能力,并提高患者的社会功能,认知干预方法的疗效可能优于技巧干预。

Objective： To compare the efficacy of cognitive and skilled rehabilitative training on theory of mind and social function deficiencies in traumatic brain injury patients. Methods： Totally 90 brain injury patients who were injured six or more months ago and whose condition was stable were selected. They were randomly as- signed into cognitive intervention group （n = 30）, skilled intervention group （n = 30） and control group （n = 30）. The cognitive intervention group received the cognitive orientated training focused on their real life behaviors, inclu- ding life events discussing, contextual play and home works. The skill intervention group received the training fo- cused on their examination skills, including the theory of mind stories comprehension, graph comprehension. The control group received normal outpatient follow-up health services. The classic Theory of Mind Tasks, Family Mem- ber Evaluated Scale of Theory of Mind in Traumatic Brain Injuries and Social Disability Screening Schedule （SDSS） were used to access the subjects＇theory of mind and social function before and after intervention, and 3 months after intervention. Results： Before intervention, there was no significant difference between the three groups on all scores. After intervention, both intervention groups had higher scores of theory of mind classic tasks [ （ 14.7 ±1.3）, （ 15.2 ± 1.7） vs. （ 12. 5 ± 1.6）, P 〈 0. 05] and family evaluated scale [ （ 128.7 ± 17.8）, （ 126. 8 ± 17.9） vs. （109. 5 ± 16. 5）, P 〈 0. 05] than the control group, and their SDSS scores were lower than control group [ （9.4±1.1 ）, （ 10. 0± 1.0） vs. （ 12. 1 ± 1.3）, P 〈 0.05 ]. There were no significant differences between the two interven- tion groups （P 〉 0.05）. Three months after the intervention, both intervention groups had higher scores of theory of mind classic tasks [（16. 5 ± 1.4）, （15.9 ± 1.2） vs. （13.3 ± 1.5）, P 〈0.05] and family evaluated scale [（146. 6 ± 15.7）, （134. 5 ± 14. 6） vs. （ 115.8 ± 21.2）, P 〈 0. 05] than the control group, and their SDSS scores were lower than control group [ （7. 1 ± 1.2）, （ 8. 0± 0. 9） vs. （ 11.4 ±0. 8）, P 〈 0. 05]. The scores of family evaluated scale was higher in the cognitive intervention group than in the skill intervention group [ （ 146. 6± 15.7） vs. （ 134. 5± 14. 6）, P 〈 0. 05], the SDSS scores was lower in the cognitive intervention group than in the skill intervention group [（7. 1± 1.2） vs. （8.0±0. 9）, P 〈0. 05]. Conclusion： It suggests that both the cognitive intervention and skill in- tervention could improve the theory of mind and the social functions in traumatic brain injury patients. The effec- tiveness of the former may be better.